后腹腔镜下肾盂输尿管切开取石术(附52例报告)

Retroperitoneal Laparoscopic Pyelo-ureterolithotomy:Report of 52 Cases

目的探讨后腹腔镜下肾盂输尿管切开取石术治疗肾盂、输尿管结石的临床疗效。方法经腹膜后腹腔镜下行肾盂输尿管切开取石术,同时切除合并的息肉。术中均放置输尿管支架管并缝合输尿管。结果52例手术均成功,取净结石,无一例中转开放手术。手术时间50～200min,平均110min。住院时间5～14d,平均7.5d。术后8周拔出支架管。52例随访6个月:术后3个月超声检查,21例肾积水消失;术后6个月超声示共32例肾积水消失,结石无复发;ECT示8例重度积水肾脏的肾小球滤过率由术前平均16ml/min升高到平均25ml/min。结论后腹腔镜下肾盂输尿管切开取石术效果确切,创伤小,术后恢复快,是治疗肾盂及输尿管上段结石的有效术式之一。

Objective To evaluate the efficacy of retroperitoneal laparoscopic pyelo-ureterolithotomy. Methods Totally 52 cases of unilateral urinary calculi were treated with retroperitoueal laparoscopic pyelo-ureterolithotomy in our hospital. All the patients received placement of ureteral stent during the operation. Results All the operations were completed successfully without conversion to open surgery. The time of the operation varied from 50 to 200 minutes with a mean of 110 minutes. The patients were discharged from hospital in 5 to 14 days （ mean, 7.5 days）. Eight weeks after the operation, the stent was withdrawn from the patients. Follow-up was achieved in all of the patients for six months. Uhrasonography showed that the hydronephrosis disappeared in 21 cases at 3 mouths, and in 32 patients at 6 months. None of the cases had recurrence. ECT showed an increased GFR in eight patients with severe hydronephrosis （increased from a mean of 16 ml/min before the operation to 25 ml/min ）. Conclusions Retroperitoneal laparoscopic pyelo-ureterolithotomy is effective, safe, and less invasive for the calculi in the renal pelvic and upper ureter.