后腹腔镜输尿管切开取石治疗输尿管上段结石

Retroperitoneoscopic ureterolithotomy in the treatment of ureteric stones in upper or middle segment of ureter

目的 总结后腹腔镜输尿管切开取石术的临床应用和经验.方法 回顾性总结分析25例经后腹腔镜输尿管切开取石术治疗的输尿管上段结石患者的临床资料及随访结果.结果 本组25例,均为输尿管中、上段结石,平均年龄（45.7±22.4）岁,其中左侧17例,右侧8例；单发21例,多发4例；结石直径1.3～2.8cm;患者均采用腹膜后途径腹腔镜下切开取石,术中均以F3或F4输尿管导管未内芯置入F5～7双J管,可吸收线妥善缝合输尿管,手术均成功,手术时间64.3±31.9min,失血（30.1±18.7）mL,术后20～48h下床活动,术后仅1例尿漏2d停止,腹膜后引流管3～5d拔除,住院时间为5～10d,随访3～24个月,输尿管无狭窄,原有积水消失或减轻.结论 后腹腔镜输尿管切开取石术治疗输尿管上段结石安全可靠,创伤小、恢复快；术中以F3或F4输尿管导管为内芯置入F5～7双J管,可以较容易置入支架管,可吸收线妥善缝合输尿管可防止术后尿漏.

Objectives To summarize the curative effect and expierences of retroperitoneoscopic ureterolithotomy in the treatment of ureteric stones in upper and middle segment of ureter.Methods The clinical and followed-up data of 25 cases with upper or middle ureteral calculi underwent techniques of retroperitoneoscopic ureterolithotomy were reviewed retrospectively.Results Patients with upper ureteral calculi were enrolled in the study.The age of patients was 45.7 ± 22.4 （range from 25 to 64） years old.With Left 17 cases,and right 8 cases ;21 cases with single stone,4 cases with more stones.The diameter of stone was 1.3 ～2.8cm;All the cases were treated by retroperitoneal laparoscopic ureterolithotomy.The mean operative time was 64.3 ± 31.9 （range from 50 minutes to 100minutes） and the estimated blood loss was 30.1 ± 18.7 （range from 20mL to 50mL）.No patient required conversion to open surgery.Blood transfusion was not necessary in this group.The techniques were double J stents were placed with F3 or F4 Ureteral catheter as bracket placed in.Sutured Ureter using Absorption line.only single one had leakage of urine for two Days.Retroperitoneal Drainage tube were displaced after 3 to 5 days after opration.The mean hospital day was 5 to 10.With 3 ～24 months＇follow up after operation,hydronephrosis was lightened or disappeared and ureterostenosis was not found with intravenous pyelography.Conclusions Retroperitoneoscopic ureterolithotomy is effective in the treatment of upper and middle ureteric stones with advantages of less trauma and blood loss,short time of hospital stay and rapid recovery from operation.The techniques were double J stents were placed with F3 or F4 Ureteral catheter as bracket placed in.Suturing Ureter using Absorption line may prevent Urinary leakage effectively.