后腹腔镜肾盂、输尿管切开取石术(附86例报告)

Retroperitoneoscopic pyelolithotomy and ureterolithotomy (report of 86 cases)

目的评价后腹腔镜肾盂输尿管切开取石术治疗肾盂及输尿管中上段结石的应用价值。方法施行后腹腔镜肾盂输尿管切开取石术86例。男48例,女38例;年龄16～72岁,平均38岁。结石直径0.8～3.2cm。左侧44例,右侧42例。其中肾盂结石6例,输尿管上段74例,中段6例,均为阳性结石。18例曾行体外冲击波碎石术(ESWL)或输尿管镜气压弹道碎石术(USL)。结果结石均1次取净。手术时间50～200min,平均70min;术后住院4～8d。结论后腹腔镜肾盂输尿管切开取石术可成为较大、质硬、长期嵌顿性肾盂输尿管中上段结石的一线治疗方法;可作为ESWL和腔内治疗失败的补救治疗措施。

[Objective] To assess the clinical value of retroperitoneoscopic pyelolithotomy （RPPL） and retroperitoneoscopic ureterolithetomy （RPUL） in treating renal pelvis or ureteral calculus. [Methods] A tolal of 86 patients with renal pelvis or ureteral calculi underwent RPPL and RPUL. 48 were man and 38 were women. Their age ranged from 16 to 72 years （mean, 38years）. The calculis were found on left side in 44 cases and on right side in 42 cases. The calculis were 0.8 to 3.2cm in diameters. Pyelolithiasis occurred in 6 cases, upper ureteral calculi in 34 cases, and middle in 6 cases. 18 had experienced unsuccessful ESWL or ureterorenolithotripsy （URL）. [Results] All the stones were completely removed by single procedure. The operation was between 50 and 200 min with a mean of 70 min, and the hospital stay was from 4 to 8 days. [Conclusions] Patients selected with large, hard, radioparent, chronically impacted pelvis or upper ureteral stones RPPL and RPUL may be considered as the first-line treatment and as a salvage procedure for failed ESWL and endoscopy.