改良经脐单孔腹腔镜输尿管切开取石术(附16例报告)

Modifiedtransumbilical laparoendoscopic single-site surgery for ureterolithotomy(Report of 16 cases)

目的:对经脐单孔腹腔镜(laparoendoscopic single-site surgery,LESS)输尿管切开取石术的取石、置管和缝合打结方法进行改良,探讨其治疗输尿管上段结石的安全性、有效性及优势。方法:2015年7月~2016年12月,采用改良经脐LESS输尿管切开取石术治疗输尿管上段结石16例,其中男10例,女6例;年龄22~66岁,平均46.25岁;左侧9例,右侧7例;结石最大直径平均1.6cm,均伴不同程度肾积水。记录手术时间、术中出血量、结石清除率、引流管留置时间、术后镇痛药应用情况及术后住院时间等。结果:16例手术均获成功,结石清除率100%。平均手术时间74(60~115)min,平均术中失血量36(20~60)ml,术后肠道恢复时间24~36h,平均引流管留置时间3d,平均术后住院时间3d。仅1例术后需静脉注射镇痛药1次。随访1~17个月,16例肾积水均获改善,无结石复发,无输尿管狭窄及严重并发症发生。结论:改良经脐LESS输尿管切开取石术治疗输尿管上段结石疗效确切,术程简便,术后疼痛轻微、住院时间短,美容效果满意,值得临床应用。

Objective： To modify the surgical technique of stone removing, stent inserting, suture and knot tying in transumbilical laparoendoseopic single-site surgery （LESS） for ureterolithotomy and to investigate the safety, effectiveness and advantages of the modified U-LESS for ureterolithotomy in treating upper ureteral calcu- li. Method： From July, 2015 to December, 2016, modified U-LESS for ureterolithotomy was performed on 16 patients with upper ureteral calculi. Of them 10 were men and 6 were women. The mean age was 46.25 （range, 22 66） years old. The calculi were found on left side in 9 cases, on right side in 7 cases. The mean diameter of the calculi was 1.6 cm. The operative time, blood loss, stone clearance, drainage tube indwelling time, application of analgesics and hospital stay were evaluated. Result： All the calculi were successfully removed once. The operative time was between 60 minutes and 115 minutes with a mean of 74 minutes. The intraoperative blood loss was 36 （range, 20-60） ml. Intestinal function recovered within 36 hours. Drainage was removed at the third postoperative day. The mean hospital stay was 3 days. Only one case was intravenously applied analgesics once. During the follow-up, no ureterostenosis or severe complication was found. Conclusion： The modified U-LESS for ureterolithotomy is effective in treating upper ureteral calculi. With the modified technique, U-LESS for uret erolithotomy will he simpler and easier. It is characterized by less pain, good cosmetic results, rapid recovery and safety. Modified U-LESS for ureterolithotomy is worth clinical promotion and application.