后腹腔镜肾盂输尿管上段切开取石术30例分析

Retroperitoneal laparoscopic pyelolithotomy and ureterolithotomy

目的：探讨后腹腔镜肾盂输尿管上段切开取石术的技术要点及临床价值。方法：采用后腹腔镜肾盂输尿管上段切开取石术30例,其中输尿管上段结石26例,肾盂结石4例。6例曾行体外冲击波碎石术失败。结果：30例手术均成功,取净结石,无一例中转开放手术。手术时间40~120 min。术中出血10~40 ml。术后住院时间5~9天。术后出现漏尿1例。术后4周拔除双J管。随访1~18个月,患者积水均减轻,未见输尿管狭窄发生。结论：后腹腔镜下肾盂输尿管上段切开取石术是治疗肾盂输尿管上段结石安全有效的微创方法,适用于结石较大、病程较长或其他方法治疗失败者,可代替开放手术。

Objective：To investigate the technical detail of retroperitoneal laparoscopic pyelolithotomy and ureterolithotomy and evaluate its clinical effect.Methods：Retroperitoneal laparoscopic pyelolithotomy and ureterolithotomy were conducted in 30 cases of unilateral urinary calculi.Stones located in renal pelvis in 4 cases and in upper ureter in 26 cases.Six cases received unsuccessful extracorporeal shockwave lithotripsy.Results：All operations were completed successfully without conversion to open surgery.The operation time was 40-120 min.The intraoperative blood loss was 10-40 ml.Postoperative hospital stay was 5-9 days.Urine leakage occurred in one patient.The double J stent tube was removed after four weeks.With 1-18 months follow-up,hydronephrosis were alleviated and no ureteral stenosis occurred in all cases.Conclusions：Retroperitoneal laparoscopic pyelolithotomy and ureterolithotomy is a safe and effective minimally invasive procedure for treatment of stones in renal pelvis and in upper ureter.It can be an alternative method for treatment of upper ureteral stones if the stone is large or impacted for a long time.