腹腔镜输尿管切开取石术不缝合输尿管的临床价值

Clinical application of transperitoneal laparoscopic ureterolithotomy with unstiched ureter in the treatment of ureteral calculi

目的：评价经腹腹腔镜输尿管切开取石术不缝合输尿管的临床价值。方法：采用腹腔镜下输尿管切开取石术治疗输尿管结石患者56例，并按是否缝合输尿管将56例患者分为两组，对比两组手术时间、术后肠功能恢复时间、镇痛药使用情况、漏尿例数、术后平均漏尿时间、住院时间和并发症发生情况，同时比较肥胖对手术时间的影响。结果：56例手术均顺利完成，无中转开放手术和脏器损伤发生。未缝合组和缝合组平均手术时间、术后肠功能恢复时间、术后镇痛药使用次数、漏尿例数、术后平均漏尿时间和住院时间分别为（55±11）rain和（73±1．0）min、（2．0±0．7）天和（1．9±0．6）天、（0．8±0．9）次和（1．0±0．9）次、4例和2例、（9．2±6．5）天和（8．3±6．0）天、（6．9±1．3）天和（6．4±1．1）天。除手术时间未缝合组明显短于缝合组外，余各项指标差异均无统计学意义。两组中肥胖者与非肥胖者手术时间比较，前者稍长，但差异无统计学意义。52例获得随访，随访时间0．5～3年，缝合组出现2例输尿管狭窄，行狭窄段丝状电极内切开术后治愈，余患者彩超显示输尿管扩张程度减轻，患肾积水消失或减轻，未见输尿管结石复发。结论：经腹腹腔镜输尿管上段结石切开取石术不缝合输尿管安全有效，手术时间缩短，并未明显增加术后漏尿情况和住院天数，是治疗输尿管结石值得推荐的方法。

Objective： To investigate the clinical effects of transperitoneal laparoscopic ureterolithotomy with unstiched ureter in the treatment of ureteral calculi. Methods：Fifty-six patients with upper ureteral calculi who un- derwent transperitoneal laparoscopic ureterolithotomy were enrolled. All of the patients were divided into two groups according to the ureter stitched or not, Clinical data and operation time, postoperative recovery time of in- testinal function, use of analgesics, leakage of urine number of cases, postoperative mean time of urine leakage, hospital stay and complications were taken into account for a contrast study. Obese degree was also measured by body mass index（BMI） in our study. Results：Operations were successful in all 56 patients, and neither converting into open surgery nor organs damaging happened. The mean operating time, recovery time of intestinal function, times of anesthetic used, number of urine leakage occurred, duration of urine leakage and time of hospital stay were （55±11）minand （73±10）min, （2. 0±0. 7）days and （1.9±0.6）days, （0.8±0.9）times and （1.0±0.9） times, 4 cases and 2 cases, （9.2±6.5）days and （8.3±6.0）days, （6.9±1.3）days and （6.4±1.1）days, respec tively. No statistical difference was found in the operative parameters between the two groups, except in operating time in which the unstiched group was much shorter then the stiched one. Besides, the operating time between pa- tients with BMI surpass 30 and that under 30 showed no difference by statistic analysis. Fifty-two cases were fi nally followed up for 6 months to 36 months, and two patients in the stiched group developed ureterostenosis who later cured through endoureterotomy by needle electrode. Ultrasonography showed hydronephrosis were reduced or disappeared in the rest patients and no recurrence of ureteral calculi oceured. Conclusions： Transperitoneal lapa- roscopic ureterolithotomy with unstiched ureter in the treatment of ureteral calculi is safe and effective along with shorter operating time, and the risk of urine leakage and time of postoperative hospital stay is not increased. This procedure is a recommendable option for the teatment of upper ureteral calculi.