后腹腔镜输尿管切开取石术28例报告

Retroperitoneal laparoscopic ureterolithotomy:a report of 28 cases

目的：探讨后腹腔镜输尿管切开取石术及处理输尿管并发病变的技术要点和疗效.方法：用后腹腔镜技术行输尿管切开取石术28例,术中发现8例结石周围有息肉包裹,1例结石处输尿管明显狭窄,摘除息肉并电灼,行狭窄段输尿管切除吻合术.结果：28例手术均获成功,手术时间50～180min,平均80min;术中出血量平均20ml;肠功能恢复时间12～24h;术后无漏尿发生,3～4d拔除腹膜后引流管,术后住院7～9d;双J管术后1个月经膀胱镜拔除.随访28例2～20个月,B超及IVU检查证实患者肾盂积水及肾功能好转,所有病例无输尿管切开处狭窄,结石无复发.结论：后腹腔镜输尿管切开取石术安全有效,可同时处理继发性输尿管病变,对于无腹膜后手术史或有开腹手术治疗指征的输尿管结石均可采用.

Objective： To explore the technical key points and the therapeutic efficacy of retropenitoneal laparoscopic ureterolithotomy and the treatment of combined diseases. Methods： Retroperitoneal laparoscopic ureterolithotomy was performed in 28 cases with ureteral calculi. Eight patients with ureteral calculi wrapped up by polyps and one patient with obvious ureteral stricture were intraoperatively found. The polyps were excised and coagulated by electric coagulation. The ureterostenosis section was resected and anastomosis was performed. Results：All operations were successful. The average operating time was 80min （ranged from 50 to 180min） and the average blood loss was 20ml. The recovery time of the enteral function was 12-24 hours. No urinary leakage was found postoperatively. The retroperitoneal drainage tube was pulled out 3-4 days after operation and the postoperative hospitalization was 7-9 days. D-J tubes were removed by cystoscope 1 month after operation. 28 cases gained the follow-up period of 2-20 months whose hydronephrosis and renal function improved via the examination of B-ultrasound and IVU. No ureteral stricture or recurrent calculi was found. Conclusions： Retroperitoneal laparoscopic ureterolithotomy is a safe and effective treatment for the urinary calculi and it can simultaneously deal with the secondary urinary pathological changes. For the patients without the history of operation on retroperitoneum and with the open operative indications on urinary calculi, retroperitoneal laparoscopic ureterolithotomy could be applied.