后腹腔镜肾盂输尿管切开取石术治疗ESWL后输尿管上段石街并肾盂结石的临床应用

Retroperitoneoscopic pyelolithotomy and ureterolithotomy in the treatment of upper ureteral steinstrasse and pyelolithiasis after ESWL

目的：探讨后腹腔镜肾盂输尿管切开取石术治疗ESWL后输尿管上段石街并肾盂结石的疗效。方法：回顾分析我院2007年3月～2013年12月间行后腹腔镜肾盂输尿管切开取石术治疗ESWL后输尿管上段石街并肾盂结石患者的临床资料,左侧18例,右侧12例;年龄16～72岁,平均40.5岁;石街均位于输尿管上段,距肾盂输尿管连接部约1.0～4.5cm,结石大小0.3～1.6cm,平均0.9cm;肾盂结石大小2.6～5.2cm,平均3.7cm;术前均曾行ESWL 2～12次,平均4次;ESWL后排石时间大于2周,平均3.8周。结果：30例均手术成功,手术时间70～150min,平均90min;术中出血量20～50ml,平均30ml;住院时间6～10d,平均7.5d;术后随访3个月～2年,所有患者肾功能均得到改善,无结石复发及输尿管狭窄发生。结论：后腹腔镜肾盂输尿管切开取石能一次手术同时解决输尿管和肾盂结石问题,具有创伤小、恢复快、住院时间短等优点,可作为ESWL后输尿管上段石街并肾盂结石的首选治疗方法。

Objective：To evaluate the efficacy of retroperitoneoscopic pyelolithotomy and ureterolithotomy in the treatment of upper ureteral steinstrasse and pyelolithiasis after ESWL.Method：We reviewed the clinical data of 30 cases who treated by retroperitoneoscopic pyelolithotomy and ureterolithotomy suffering from upper ureteral steinstrasse and pyelolithiasis after ESWL from March 2007 to December 2013 at First Affiliated Hospital of Zhengzhou University.Eighteen lesions were on the left ureter and twelve were on the right.Patients＇ mean age was 40.5（range,16-72）years.Stones located at the upper ureter,1.0-4.5cm far from ureteropelvic junction.The mean stone size was 0.9（range,0.3-1.6）cm.The renal pelvis stones ranged from 2.6to 5.2cm in size（mean 3.7cm）.All cases experienced 2-12（mean,4）times of ESWL unsuccessfully preoperatively.Average time to stone expulsion was 3.8weeks.Result：All the operations were successful.The mean operation time was90（range,70-150）min,and the mean blood loss was 30（range,20-50）ml.Moreover,the mean hospital stay was 7.5（range,6-10）days.During the follow-up period of 3-24 months,there was no ureteric stricture or recurrent calculus,and all patients＇ renal function improved.Conclusion：Retroperitoneoscopic pyelolithotomy and ureterolithotomy has the advantages of less trauma,less hospital stay and quicker recovery,so it can be considered as the first-line treatment in the patients with upper ureteral steinstrasse and pyelolithiasis after ESWL.