后腹腔镜输尿管上段切开取石术的手术要点及并发症处理

Operation techniques and complications treatment of retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi

目的：探讨后腹腔镜输尿管上段切开取石术的手术要点及并发症的处理措施。方法：回顾分析为75例患者行后腹腔镜输尿管上段切开取石术的临床资料,其中男41例,女34例;22～62岁;左侧47例,右侧28例;结石最大径1.5～2.8 cm。结果：手术时间60～140 min,术中出血量30～50 ml;术后6～14 d出院;术后4周拔除D-J管。术后随访3～48个月,1例患者出现输尿管狭窄。结论：后腹腔镜输尿管上段切开取石术具有患者创伤小、康复快等优点,其并发症主要为输尿管损伤、周围脏器损伤、出血、漏尿及输尿管狭窄等,熟悉手术操作要点、严格掌握适应证是减少并发症发生的关键。

Objective：To discuss the operation techniques and complications treatment of retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi. Methods：Seventy-five patients with upper ureteral calculi who underwent retroperitoneal laparoscopic ureterolithotomy were included in this study ,41 patients were male and 34 patients were female ,47 in left and 28 in fight, the age ranged from 22 to 62 years old. The calculi size was 1.5-2.8 cm. The clinical data of these patients were retrospectively analyzed. Re- suits ：The operative time ranged from 60 to 140 rain. The intraoperative blood loss was 30-50 ml. The inpatient time was 6-14 d after op- eration, D-J tubes were removed 4 weeks after operation. All patients were followed up for 3-48 months, 1 patient suffered from ureteral stricture. Conclusions ： The retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi has advantages of minimal trauma and fast recovery. The main complications are ureteral injury, damage of surrounding organs, bleeding, urine leakage, stricture of ureter and so on. The skilled operation techniques and the strict grasp of indication is the key to reducing complications.