腹腔镜下两种方法治疗息肉嵌顿的上段输尿管结石疗效比较

Comparison of Two Different Procedures in Laparoscopic Treatment of Impacted Upper Ureteral Calculi with Inflammatory Polyps

目的探讨腹腔镜治疗炎性息肉嵌顿的输尿管结石的方法。方法 2005～2011年,采用经腹腹腔镜治疗28例炎性息肉嵌顿的输尿管结石。息肉长径2.5～4.5 cm,包绕结石生长。前10例行输尿管切开取石加息肉切除术(息肉切除组),后18例行输尿管切开取石加息肉段输尿管切除吻合术(输尿管切除组)。观察术后漏尿、输尿管狭窄和肾积水改善情况。结果 28例手术均顺利完成。息肉切除组术后漏尿2例,经充分引流分别于术后2周和1个月自愈;输尿管切除组未见漏尿,但2组术后漏尿发生率差异无显著性(P=0.119)。28例随访6个月～3年,平均12个月。彩超、IVU显示息肉切除组3例病变段输尿管狭窄,其中2例行输尿管镜丝状电极内切开术治愈,1例2次行内切开后狭窄复发予腹腔镜输尿管狭窄段切除吻合术治愈;输尿管切除组未见吻合处输尿管狭窄,2组比较差异有显著性(P=0.037)。结论输尿管结石伴炎性息肉嵌顿时,应行经腹腹腔镜输尿管切开取石及病变段输尿管切除吻合术,安全可靠,术后输尿管狭窄少。

Objective To search for a proper procedure in laparoscopic treatment of ureteral calculi with inflammatory polyps.Methods The clinical data of 28 patients with ureteral calculi impacted by inflammatory polyps were summarized,all of whom underwent laparoscopic surgery from 2005 to 2011.The size of polyps ranged from 2.5 cm to 4.5 cm.Laparoscopic ureterolithotomy and polypectomy were carried out in the first 10 cases（polypectomy group）,and modified procedure of ureterolithotomy and ureterectomy were performed in the following 18 cases（ureterectomy group）.Urine leakage,ureterostenosis and improvement of hydronephrosis were recorded during the follow-up.Results Operations were successful in all 28 patients.Urine leakage occurred in 2 patients in polypectomy group,who recovered 2 weeks and 1 month respectively after postoperative drainage.No urine leakage was observed in ureterectomy group,but no statistical differences were found between the two groups in urine leakage（P=0.119）.All 28 patients were followed up for 6 months to 3 years,with an average of 12 months.Color Doppler ultrasound and intravenous urography（IVU） examination showed that 3 patients in polypectomy group developed ureterostenosis,who underwent endoureterotomy by needle electrode later as remedies,and 2 were cured.The other one who failed endoureterotomy was cured by laparoscopic end to end anastomosis.No ureterostenosis occurred in ureterectomy group.The ureterostenosis rate between the two groups had statistical differences（P=0.037）.Conclusion Transperitoneal laparoscopic ureterolithotomy and ureterectomy for the treatment of upper ureteral calculi impacted by inflammatory polyps is safe and has lower rate of ureterostenosis.