单孔与常规腹腔镜经脐入路治疗输尿管结石的对比研究

Laparoendoscopic Single-site Ureterolithotomy for Upper Ureteral Stone Disease:A Comparison with Conventional Laparoscopic Surgery

目的探讨单孔与传统腹腔镜经腹腔人路治疗输尿管上段结石的临床疗效。方法前瞻性比较2010年1月～2012年5月60例单孔和常规腹腔镜经腹腔人路患者资料、手术时间、费用、术后疼痛及术后美观，并分析两组间的并发症。结果60例手术均获成功，无并发症发生；手术时间30～75min，平均手术时间48．5±9．3min；LESS组在切口数量、术后疼痛评分方面与常规组相比有统计学差异（P〈0．05），两组在手术时间、术后并发症、术后住院时间方面差异无统计学意义（P〉0．05）。LESS组术后出现漏尿1例，经保守治疗治愈，住院时间2—6天，平均住院时间4．3±0．9天；术后随访时间8～18个月，平均随访时间12．4±2．5个月，B超、IVP检查未见输尿管狭窄，结石无复发。结论LESS经脐腹腔镜输尿管切开取石治疗输尿管上段结石是可行的、安全的、有效的，与常规腹腔镜下输尿管切开取石术相比，有相同疗效，但术后切口更美观，创伤更小、术后疼痛更轻的特点。

Objective To compare the feasibility and outcomes of LESS and conventional laparoscopic surgery via the transperitoneal approach in the management of upper ureteral stone. Methods In this prospective randomized study from January 2010 to May 2012, 60 patients with ureteral stones underwent transperitoneal conventional laparoscopic ureterolithotomy or LESS ureterolithotomy. Demographic and clinical characteristics as well as postoperative data were collected and analyzed. Results The procedures were successful in all 60 cases. No surgical complications occurred. Mean follow - up period was 12.4 months （8 - 18 months） and showed no recurrence or uret- erostenosis. The difference in visual pain analog score between the 2 groups was statistically significant. There are not significant differ- ence between conventional laparoscopic ureterolithotomy and LESS ureterolithotomy in the operating time, the surgical complication. Con- clusion LESS for ureterolithotomy through the transperitoneal approach is feasible and safe and effective. It can acquire outcomes equal to those of conventional laparoscopic surgery. It has the advantage of good cosmetic outcome, less damage, rapid recovery.