后腹腔镜输尿管切开取石术技巧总结（附61例报告）

Summarizing technique of retroperitoneal laparoscopic ureterolithotomy for upperureteric calculi ： report of 61 cases

目的探讨后腹腔镜输尿管切开取石术治疗输尿管上段结石的手术技巧。方法回顾性分析采用后腹腔镜输尿管切开取石术治疗输尿管上段结石61例患者的临床资料，结石直径6～26mm，平均12．7mm，其中58例患者病程大于2个月。镜下放置5F～7F输尿管双J管并缝合输尿管切口。结果61例手术有2例中转开放手术，其余59例均获成功；手术时间40～135min，平均53min；术中出血平均18ml；腹膜后引流管留置术后1-4天拔除，双J管术后2～4周拔除，无尿漏等并发症发生，术后住院时间4～9天。52例获随访2～24个月，所有患侧肾积水好转，无结石复发、输尿管狭窄等并发症出现。结论采用合理的手术技巧，术中快速放置双J管，后腹腔镜输尿管切开取石术损伤小、手术时间较短、术后恢复快、疗效确切，并发症少，是治疗输尿管上段结石可选择的微创方法，对于元腹膜后手术史，结石较大、其他治疗方法失败者可作为首选术式。

Objectives To summarize the technical detail of retroperitoneal laparoscopic ureterolithotomy （RLU） for upperureteric calculi. Methods The clinical data of 61 cases underwent RLU were retrospectively analyzed, the diameters of the calculi varied from 6 to 26 mm, the average was 12.7 mm, the courses of the disease of 58 patients were more than 2 months. All the cuts of ureters were well sutured and D - J tube of 5 - 7 F were well placed. Results of all the cases,59 patients underwent RLU successfully, only 2 case converted to operation. ;the time consuming of the operations ranged from 40 to 135 minutes,the average was 53 minutes;the average of the amount of blood loss were 18 ml ; the time of retaining of the draining tube after operation ranged from 1 to 4 days, D - J tubes were removed 2 to 4 weeks after operation, without complications such as leakage of urine, etc. The postoperative hospital stay was 4 to 9 days, During the follow - up period of 52 cases , there was no ureteric stricture or recurrent cal- culus had been found,and all patientstenal function had been improved. Conclusions Our experience indicates that operative techniques such as placing a duble J tube quickly shorten the operation time of RLU. As a kind of micro - insult operation for upperureteric calculi, RLU is very safe and effective, especially to the cases without history of retroperitoneal oprations, big calculi, severe hydronephrosis, or the cases which failed in other ways.