31例后腹腔镜输尿管切开取石术治疗输尿管上段结石的临床分析

The clinical analysis of retroperitoneoscopic ureterolithotomy for upperureteric calculi

目的探讨后腹腔镜输尿管切开取石术治疗输尿管上段结石的技术要点及临床价值。方法后腹腔镜输尿管切开取石术31例，均为输尿管上段结石，结石直径5-24mm，平均13．5mm，26例患者病程大于2个月。31例均缝合输尿管切口并放置双J管。结果1例因结石退回肾需改行体外冲击波碎石（ESWL），其余30例手术均获成功；手术时间40～135min，平均62min；术中平均出血量为20ml；术后腹膜后引流管留置2～7天拔除，无漏尿等并发症发生，术后住院时间4～9天。随访2～16个月，所有患侧肾积水好转，无严重并发症出现。结论后腹腔镜输尿管切开取石术是治疗输尿管上段结石的微创方法，安全有效，对于无腹膜后手术史，结石较大、肾积水较多或其他治疗方法失败者可作为首选术式。

Objective To approach the emphasis of technique and clinical value of Retroperitoneoscopic ureterolithotomy for upperureteric calculi.Methods We chose 31 cases of Retroperitoneoscopic ureterolithotomy for upperureteric calculi,the diameters of the calculi varies from 5 to 24 mm,the average is 13.Smm,the courses of the disease of 26 cases are more than 2 months.All the cuts of ureters were well sutured and D-J tube were well placed in these 31 cases.Results 1 case was altered to ESWL because calculus＇s going back to renal pelvis,other 30 operations were all succeeded;the time consuming of the operations varies from 40 to 135 minutes,the average is 62 minutes;the average of the amount of blood loss were 20 ml;the time of retaining of the draining tube after operation varies from 2 to 7 days,without complications such as leakage of urine,etc.The time of being in hospital varies from 4 to 9 days,and after follow up visiting for 2 to 16 months,all the hydronephrosis of the patients improved,without any severe complication happened.Conclusions As a kind of micro-insult operation for upperureteric calculi.Retroperitoneoscopic ureterolithotomy is very safe and effective, especially to the cases without history of oprations of retroperitoneoscope,big calculi,severe hydronephrosis,or the cases which failed in other ways.