后腹腔镜下输尿管切开取石术(附25例报告)

Retroperitoneoscopic ureterolithotomy(The experience of 25 cases)

目的：探讨后腹腔镜下输尿管切开取石术的技术要点及临床价值。方法：采用腹腔镜下腹膜后输尿管切开取石术25例，其中6例于术前行ESWL治疗失败；其余19为初次手术治疗。结石直径4～25mm．平均14mm。多数患者病程大于2个月，最长为10年。25例均缝合输尿管切口并放置双J管。结果：1例因结石退至肾盂后改为开放手术，其余24例手术均获成功；手术时间45～120min，平均60min；除1例发生漏尿，其余术后3～9天拔除腹膜后引流管，术后住院时间6～9天。随访2～13个月．无严重并发症出现。结论：后腹腔镜下输尿管切开取石术是安全有效的治疗输尿管上段结石的微创方法，适用于结石较大，病程较长或其他治疗方法失败者，可部分代替传统开放手术。

Objective： To investigate the technical detail of retroperitoneoscopic ureterolithotomy and evaluate its clinical effect. Methods： From November 2006 to December 2007, retroperitoneoscopic ureterolithotomy was carried out in 25 patients, 6 of whom were treated using this method as a salvage procedure after unsuccessful ESWL. The stone size ranged from 4425 mm（mean 14 mm） with the incarceration time from 1 months to 10 years. Results：Retroperitoneoscopic ureterolithotomy was successful in 24 patients, with one failure being an early case in this series. The operation time ranged from 45 to 120 minutes （mean 60 minutes）, and the blood loss ranged from 10 to 30 ml, urine leakage occurred in one patient. The mean hospital stay was 349 days. During the follow up period of all the cases, there was neither ureteral stricture nor recurrent calculus. Conclusion：Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive procedure. It can be an alternative method for the treatment of upper ureteral stones if the stone is large or impacted for a long time.