经腹腹腔镜治疗输尿管下段结石35例临床分析

Transperitoneal laparoscopic ureterolithotomy for distal ureteral stones:a report of 35 cases

目的：总结腹腔镜治疗输尿管下段结石的经验。方法输尿管下段嵌顿性结石患者35例，左侧16例，右侧19例，单侧输尿管多发性结石2例，结石最大直径1.3-2.5 cm，平均直径（1.85±0.50）cm，均采用经腹腔途径完成腹腔镜输尿管切开取术，术中留置输尿管支架管及手术部位引流管，其中5例输尿管下段狭窄，取石并切除狭窄段后施行输尿管膀胱再接术。结果35例输尿管下段结石经腹腹腔镜切开取石和5例兼行输尿管膀胱再植术，全部成功，效果满意。手术时间30-130分钟，平均（65.30±28.14）分钟，术中出血量10-150 ml，平均（40.57±26.51） ml，术后住院时间5-10天，平均（6.92±1.15）天。术后引流管拔除时间2-4天，平均（3.80±1.33）天。术中均未见肠管及邻近脏器损伤，术后未发生感染、漏尿，输尿管膀胱再植术者未出现输尿管反流和输尿管下段再狭窄。结论经腹腔入路腹腔镜输尿管下段切开取石术，结石取净率高，创伤小，恢复快。

Objective To summarize the experiences of transperitoneal laparoscopic ureterolitho-tomy for distal ureteral stone and discuss the value of this surgery for incarcerated ureteral calculus. Meth-ods A total of 35 patients with distal ureteral stones were enrolled,including 16 cases on the left side and 19 cases on the right side. Two patients had multiple stones at the same side. The diameter of the stone ranged from 1. 3 - 2. 5 cm,with an average of（1. 85 ± 0. 50）cm. All patients received laparoscopic ureterolithotomy and were implanted with urethral stent and drainage tube. Five patients with ureterosteno-sis received additional urinary reconstruction after stenosis resection. Results All surgeries were success-fully performed and the results were satisfactory. The operation time ranged from 30 - 130 min,with an av-erage of（65. 30 ± 28. 14）min. The intraoperative blood loss ranged from 10 - 150 ml,with an average of （40. 57 ± 26. 51）ml. The hospital stay ranged from 5 - 10 days,with an average of（6. 92 ± 1. 15）day. The extubation time ranged from 2 - 4 days,with an average of was average（3. 80 ± 1. 33）day. No complica-tions such as organ injuries,infection,vsipoueteral reflux syndrome or restenosis occurred. Conclusion For distal ureteral stones,transperitoneal laparoscopic ureterolithotomy has the advantages of high stone clearance rate,minimal trauma and quick recovery.