后腹腔镜输尿管切开取石术的临床研究

Clinical study for retroperitoneoscopic uroterolithotomy

目的探讨后腹腔镜输尿管切开取石术的临床应用及技术改进。方法后腹腔镜输尿管切开取石术148例(159侧),对术中寻找输尿管、置放双J管及处理输尿管切口等技术进行改进。结果 145例(156侧)顺利完成手术;3例(侧)因术中结石移位至肾内,再行肾盂切开取石,2例成功,1例失败改开放手术。手术时间(单侧)20～65min,平均38min。出血量约5～120mL,平均36mL。术后3～6d停切口引流管,4～8d停导尿管,4周拔出双J管。住院时间6～11d,平均8.2d。141例获得随访3～28个月(平均17.6个月),1例术后11个月结石复发,予以ESWL治愈;1例术后15个月IVU检查发现输尿管狭窄,行输尿管镜下钬激光切开术治愈。未见其他并发症。结论后腹腔镜输尿管切开取石术微创、安全、效果好。虽技术要求高,但随经验增加和技术改进,手术时间可短于开放手术,一般可替代开放手术。

【Objective】To evaluate and promote the technique of retroperitoneoscopic uroterolithotomy in the treatment of ureteral calculus.【Methods】A total of 148 patients were performed laparoscopic uroterolithotomy on 159 sides with the technique meliorated,including exposure of ureter,introduction of double-J stent and the management of ureteral incision.【Results】The stones in 145 patients（50 sides） were successfully removed by uroterolithotomy.In three cases,the stones moved upper to the kidney,and retroperitoneoscopic pelviolithotomy was undergone subsequently,two cases were successful,one case was frustrated and conversed to open processes.The operative time ranged from 20～65（mean,38 min）.Blood loss range from 5 to 120 mL（mean,36 mL）.Postoperatively,the retroperitoneal drainage-tubes were removed 3～6 days after the stop of urine leakage.The catheters were removed in 4 to 8 days,and the double J stents were removed in 2 to 4 weeks.The hospital stay was 6 to 11 day（mean,8.2 days）.Postoperatively 141 patients were available in the follow-up of 3 to 28 months（mean 17.6 months）,there was 1 case of recurrent calculus and relived with ESWL;1 case of ureteral stenosis,and that was cured by Holmium laser section under ureteroscope.There was no other complication.【Conclusions】Retroperitoneoscopic ureterolithotomy are useful and effective alternative treatment techniques to open surgery when first-line treatments have failed or are unlikely to be effective.With technique improvement,the operative time could be getting shorter,and even shorter than that of open method.