首选后腹腔镜治疗复杂性输尿管上段结石的可行性分析

Feasibility Analysis for the Primary Approach for Complex Proximal Ureteral Stones with Retroperitoneal Laparoscopic Ureterolithotomy

目的:探讨首选后腹腔镜切开取石术治疗复杂性输尿管上段结石的可行性。方法:回顾性分析2008年11月～2010年6月术前确诊为复杂性输尿管上段结石并行后腹腔镜输尿管切开取石术24例患者的临床资料。结果:23例手术获得成功,手术时间65～130 min,平均79.6 min;术中出血10～50 ml,平均20.1 ml。术后随访3～22个月,平均9.1个月,恢复良好。1例因ESWL后1周内行后腹腔镜左输尿管切开取石术,术中见输尿管周围粘连明显,不易分离,损伤左肾下极迷走动脉而改行开放手术。结论:后腹腔镜输尿管切开取石术可安全有效地治疗复杂性输尿管上段结石,有望作为治疗复杂性输尿管上段结石的首选方法。

Objective： To evaluate the feasibility of retroperitoneal laparoscopic ureteroLithotomy m complex proximal ureteral stones. Methods：The clinical data of 24 patients, from November 2008 to June 2010,who underwent retroperitoneal laparoseopic ureterolithotomy for the complex proximal ureteral stones was retrospectively analyzed. Rcsults：A retroperitoneal approach was performed in 23 patients. Operative time ranged from 65 to 130 rain （mean, 79.6 rain）. The intraoperative blood loss ranged from 10 to 50 ml （mean,20.1 ml）. No postoperative complications were encountered,and patients were discharged between 3 to 22 months （mean, 9.1 months） after surgery. In one case,which patient underwent extracorporeal shock-wave lithotripsy（ESWL） unsuccessfully in one week, the left renal abnormal artery was injured during retroperitoneal laparoscopic ureterolithotomy, necessitating conversion to open surgery. Conclusions： Retroperitoneal laparoscopic ureterolithotomy for complex proximal ureteral stones was safe and effective. It was considered to be a first--line intervention for the surgical management of complex proximal ureteral stones.