腹腔镜下经肠系膜途径行左侧输尿管上段切开取石术(附10例报告)

Transmesentric Laparoscopic Ureterolithotomy on the Left Side(Report of 10 Cases)

目的:探讨腹腔镜下经肠系膜途径行左侧输尿管上段切开取石术的临床经验和疗效。方法:常规制备气腹;进入腹腔后不游离结肠,在腹腔镜下透过肠系膜辨认扩张的肾盂、输尿管,直接在降结肠系膜无血管区开窗,游离输尿管上段,行输尿管切开取石术。采用此术治疗左侧输尿管上段结石患者10例,记录患者的性别、年龄、身体质量指数(BMI)、手术时间、术中出血量、术后恢复饮食时间和下地活动时间、住院时间、术后症状改善以及B超和IVU复查结果。结果:10例手术均获得成功,平均手术时间(56.2±19.5)min,平均术中出血量(28.7±8.1)ml,恢复饮食和下床活动平均时间分别为18 h和12 h;术后平均住院时间6.5天。随访6～42个月,平均24.1个月,临床症状消失,复查B超和静脉肾盂造影(IVU),输尿管无狭窄,肾积水消失或减少,肾功能改善。结论:对体形瘦、肠系膜脂肪少的初次手术患者,经结肠系膜途径行左侧输尿管上段切开取石术安全有效,可以减少创伤,缩短手术时间。

Objective：To describe the technique and evaluate the outcome of transmesentric laparoscopic ureterolithotomy on the left side. Methods： After entering the peritoneal cavity, a window was made into the descending mesocolon in an avascular area with no left colon reflection. Upper ureter was dissected through this window and the ureterolithotomy was performed . 10 cases of patients with laparoscopic ureterolithotomy on the left side were treatmented by this method. For each patient age, gender, body mass index（BMI）, operative time, blood loss, time to resumption of oral intake and complications, hospital stay were recorded. Results： Operations succeeded in all 10 patients, mean operative time was （56.2± 19.5）min and estimated blood loss was （28.7±8.1）ml. The mean time to resumption of oral intake was 18 hours and the time of ambulation was 12 hours. The mean hospital stay was 6. 5 days and the mean follow-up was 24.1 months（range to 6-42 month）. All the patients were as sessed with physical examination, abdominal ultrasound and IVU, they were demonstrated improved drainage with no evidence of stenosis and with no symptoms. Conclusions： Laporoscopic ureterolithotomy with the direct access through the mesentero-colic space on the left side is a safe and effective technique, which enables a shorter operative time and quicker recovery without increasing morbidity,especially for slim patients.