后腹腔镜下肾盂切开取石术联合输尿管镜治疗多发性肾结石

The application of retroperitoneoscopic pyelolithotomy combined with ureteroscope in the treatment for multiple renal calculi

目的探讨在多发性肾结石的治疗中,后腹腔镜下肾盂切开取石术联合输尿管镜的可行性和安全性。方法回顾性分析2014年3月至2017年3月我院收治的多发性肾结石患者10例为研究对象,行后腹腔镜肾盂切开联合输尿管镜碎石取石术,观察患者的手术情况、手术时间、术中出血量、肾功能变化、术后住院时间及结石清除率等。结果 10例手术均成功,一期结石清除率为100%,平均手术时间(143±23)min,平均术中出血量(98±39)ml,术后平均住院时间(6.5±1.0)d。10例患者术前和术后6 h肌酐改变差异无统计学意义(P>0.05)。围手术期有1例患者发生尿瘘,保守治疗无效后于术后1个月再次行输尿管镜下双J管置入术,现已痊愈。所有患者术后复查腹平片未见结石残留,术后平均随访(10±5)个月,未发现吻合口狭窄,无继发性肾结石形成。结论在选择性病例中,后腹腔镜联合输尿管镜碎石取石术是安全可行的。

Objective To investigate the feasibility and safety of retroperitoneoscopic pyelolithotomy combined with ureteroscopy for the treatment of multiple renal calculi.Methods The clinical date of 10 cases underwent retroperitoneal laparoscopic pyelolithotomy combined with ureteroscopic lithotripsy in our hospital during March 2014 to March 2017 were analyzed retrospectively.The operation time,intraoperative blood loss,renal function,postoperative hospital stay and stone clearance rate were recorded.Results All operations were successful.The first phase stone-free rate was 100%,average operative time was(143±23)min,average blood loss was(98±39)ml,mean postoperative hospital stay was(6.5±1.0)d.The changes in creatinine were not different significantly between before and after surgery(P>0.05).One case occurred urinary fistula during the perioperation and had recovered through double J ureteral stent implantation.No anastomotic stricture or secondary kidney stones were found after(10±5)months follow-up.Conclusions In selected cases,retroperitoneal laparoscopic pyelolithotomy combined with ureteroscope lithotrips is feasible and effective for multiple renal stones.