腹腔镜输尿管上段切开取石术的技巧及并发症的处理

Techniques and complications management of laparoscopic upper ureter lithotomy

目的:探讨腹腔镜输尿管切开取石术的手术技巧及常见并发症的处理。方法:回顾性分析2005～2010年间,在我科行腹腔镜输尿管上段切开取石术的89例患者资料,其中15例之前行输尿管镜碎石失败,22例行ESWL失败,其他52例结石大于1.5cm,伴有中到重度肾积水,其中3例孤立肾结石平均大小1.7cm。均经腹腔途径,保留双J管,间断缝合输尿管。结果:无中转开放,86例取出结石,结石清除率96.6%,3例结石漂移,其中1例最终未能处理,2例在输尿管软镜辅助下取出结石。3例患者发生尿漏,均保持引流通畅后自愈,1例严重血尿,保守治疗后缓解。结论:腹腔镜输尿管切开取石术是体外冲击波碎石和输尿管镜碎石术失败后的有效补救术式,也可以作为较大的(>1.5cm)、积水显著的嵌顿结石尤其是孤立肾结石的首选术式,结石清除率高,也较为更安全。

Objective：To investigate the surgical techniques and treatment of common complications of laparo- scopic upper ureter lithotomy. Method：The data of 89 cases （2005 to 2010, Department of Urology, Zhongshan Hospital） underwent laparoscopic upper ureter lithotomy were analyzed retrospectively, among them 15 cases had the failure of transureteroscopic lithotripsy before, 22 cases had the failure of extracorporeal shock-wave litho- tripsydisease（ESWL）. Stones of the other 52 cases were greater than 1.5 cm, and with moderate to severe hydro- nephrosis, three of them were solitary kidney stones（average size 1.7 cm）. All operation were characterized by ahdominal approach, and retained D-J tube. Ureter was dosed with interrupted sutures. Result：No patient was converted to open surgery, stones of 86 were removed, and the stone clearance rate was 96.6%. stones of three patients were drift and one of them was unable to handle, 2 patients were assisted with the flexible ureteroscope to remove the stones. 3 patients occurred urinary leakage, were kept unobstructed drainage and healing. One case oc- curred severe hematuria, and alleviated after conservative treatment. Conclusion; Laparoscopic ureterolithotomy is an effective remedy after the failure of extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy, which can be used as preferred surgical approach for large stones （〉1.5 cm）, stones with severe hydronephrosis,and especially the solitary kidney stones with high stone clearance rate and safer.