腹膜后腹腔镜输尿管切开取石术治疗上段输尿管嵌顿性结石35例报告

Retroperitoneal laparoscopic ureterolithotomy for treatment of impacted upper ureteric calculi:a report of 35 cases

目的：探讨腹膜后腹腔镜输尿管切开取石术（retroperitoneal laparoscop ic ureterolithotomy,RPLU）治疗上段输尿管嵌顿性结石的可行性、疗效及手术技巧。方法：回顾分析2007年6月至2009年12月为35例上段输尿管嵌顿性结石患者行RPLU的临床资料。结果：35例均顺利完成RPLU,其中32例同时行腹腔镜输尿管炎性息肉电凝毁损术,3例行狭窄段输尿管切除＋输尿管端端吻合术,手术时间45~127m in,平均83m in,出血量5~30m l,平均14.5m l,无术中大出血发生,术后3~6d出院,无尿漏,复查尿路平片（k idney ureter b ladder,KUB）及B超示无结石残留,4~6周拔除双＂J＂管。随访所有病例6~35个月,平均19个月,KUB及B超检查无结石复发及输尿管狭窄,27例中度肾积水患者3~6个月后缓解为轻度肾积水,12~18个月后积水基本消失;8例重度肾积水患者6~9个月后缓解为中度肾积水,10~35个月缓解为轻-中度肾积水。结论：RPLU是治疗上段输尿管嵌顿性结石的微创手段,具有与开放手术同样肯定的疗效,且具有患者创伤小、痛苦轻、康复快等优点,对挽救患者患侧肾功能具有非常重要的意义,值得临床应用与推广。

Objective：To explore the feasibility,therapeutic effect and operative technique of retroperitoneal laparoscopic ureterolithotomy（RPLU） for treatment of impacted upper ureteric calculi.Methods：The clinical data of 35 patients suffered from impacted upper ureteric calculi and underwent RPLU between Jun.2007 and Dec.2009 was analyzed retrospectively.Results：RPLU was successfully performed in all cases,laparoscopic ureteral inflammatory polyp electrocoagulation ablation was performed in 32 cases,resection of ureteral stricture and ureteral end-end anastomosis in 3 cases.The operation time was 45-127min（mean,83min）.The intraoperative blood loss was 5-30ml（mean,14.5ml）.No massive bleeding occurred during the operations.The postoperative hospital stay was 3-6d.No urine leakage and no stone left were reviewed by kidney ureter bladder（KUB） and B-ultrasound.Double ＂J＂ tubes were removed after 4-6 weeks.During the follow-up of 6 to 35 months（mean,19 months）,35 cases showed no stone recurrence and no ureteral stricture in KUB and B-ultrasound.27 patients with moderate hydronephrosis relieved to mild ones in 3-6 months,hydrops disappeared in 12-18 months.Eight patients with severe hydronephrosis relieved to moderate in 6-9 months and to mild-moderate in 10-35 months.Conclusions：RPLU for treatment of impacted upper ureteric calculi is mini-invasive,as effective as open surgery,and has advantages of less pain and quicker recovery.It has very important significance to save ipsilateral renal function,so it is worthy of generalization.