后腹腔镜下输尿管切开取石治疗输尿管上段结石的临床分析

Clinical Analysis of Retroperitoneal Laparoscopic Ureteral Calculi in the Treatment of Upper Ureteral Calculi

目的：探讨后腹腔镜下输尿管上段切开取石手术技巧及临床价值。方法：选取2014年3月-2015年5月本院收治的10例输尿管上段结石患者作为研究对象,所有患者均采用后腹腔镜下输尿管切开取石术,其中7例为初次手术治疗,3例于术前行体外冲击波碎石术（Extracorporeal shock wsve lithotripsy,ESWL）或输尿管镜手术治疗失败,10例均缝合输尿管切口并放置F5双J管。结果：1例因未能找到结石段输尿管改为开放手术,其余9例手术均在腹腔镜下成功取石,手术时间60~240 min,平均（85.7±5.3）min;术中出血约30~300 m L,平均（60.5±5.4）m L;术后2~4 d拔除腹膜后引流管,术后住院时间5~7 d,平均（5.8±0.5）d。随访6~13个月,所有患者肾积水均减少或消失,且未发生漏尿、输尿管狭窄或结石复发。结论：后腹腔镜下输尿管切开取石术安全有效,具有手术创伤小、住院时间短、患者痛苦少及术后恢复快的优点,值得基层医院临床推广。

Objective： To explore the technique and clinical value of retroperitoneal laparoseopic ureterolithotomy in the treatment of upper ureteral calculi,Method： From March 2014 to May 2015, 10 cases of upper Ureteral calculi in our hospital were selected as the research objects, they were all treated with retroperitoneal laparoseopie ureterolithotomy.7 cases were treated for the first time, the other 3 cases were treated after failing with ESWL or ureteroseopie operation.The ureter incisions were sutured and the F5 double-J tubes were placed in 10 cases.Result： 1 case was changed to open operation because failed to find ureteral calculi, the remaining 9 cases were successfully removed stones by laparoseopie surgery.The operation time was 60-240 min, the average was （ 85.7 ± 5.3 ） min.The intraoperative blood loss was 30-300 mL, the average was （ 60.5±5.4 ） mL.Retroperitoneal drainage-tubes were removed for 2-4 days after surgery, the postoperative hospital stay was 5-7 days, the average was （ 5.8 ± 0.5 ） d.All cases were followed up for 6-13 months, uronephrosis had decreased or disappeared, and no leakage, ureteral stricture or stone recurrence.Conclusion： Retroperitoneal laparoscopic ureterolithotomy is safe and effective, it has advantages of less surgical trauma, shorter hospital stay, less pain and quick recovery, worthy of clinical promotion in primary hospital.