后腹腔镜输尿管切开取石术中防止结石移位的改良方法

An improved method to prevent the stones shift in retroperitoneal laparoscopic ureterolithotomy

目的探讨应用一个血管夹防止后腹腔镜输尿管切开取石术术中结石移位的临床应用价值。方法 2006年3月至2009年6月共收治输尿管上段结石患者58例,随机分组后所有患者均行后腹腔镜输尿管切开取石术。26例术中采用无损伤血管夹钳夹结石上方输尿管再行输尿管切开取石,32例术中直接切开输尿管取石,两组术中均留置双J管,比较两组的总手术时间、取石时间、术中出血量及术后随访手术疗效。结果 58例手术全部成功,无一例中转开放手术,术中均无输血。两组在手术时间、术中出血量及住院时间上差异均无统计学意义。血管夹组较直接切开取石组取石时间短。两组术后复查均未见结石残留,无并发症发生。结论术中应用血管夹可防止结石向输尿管上方移位,降低取石难度,缩短术中取石时间,有临床应用价值。

Objective To prevent the stones shift, we used a vascular clamp in retroperitoneal laparoscopic ureterolithotomy and evaluated its chinical application value. Methods Fifty-eight patients who had upper urinary tract calculi were enrolled in this study. All patients underwent retroperitoneal laparoscopic urcterolithotomy. Non-invasive vascular clamp were used to block the ureter at the top of ureteral stones before ureterolithotomy in 26 cases. Ureterolithotomy were performed directly in 32 cases without vascular clamp. Double J stents were palced in two groups as internal stent and internal drainage. The total operation time, time of stone removal, blood loss and postoperative follow-up outcome were compared between two groups. Results All the operations were successful with no case tranfered to open operation. No case in two groups had no blood transfusion. No statistical difference was found in the total operation time, blood loss and length of hospital stay between two groups. Time of stone removal in vascular clamp group was significantly shorter than in no vascular clamp group. No postoperation calculus remained and no postoperative complications occurred at postoperative visit in both groups. Conclusions Using vascular clamp at the top of ureteral stones before ureterolithotomy can prevent stone displacement and reduce the difficulty of stone removal, resulting in less time of stone removal. It has important clinical value to use vascular clamp in the surgery of retroperitoneal laparoscopic ureterolithotomy.