经后腹膜腔镜下行输尿管切开取石疗效观察  

The clinical study of retroperitoneoscopic ureterolithotomy treating complex upper urinary tract calculi

作　　者：高敬峰[1] 朱江宁[1] 侯平英[1] 马永宏[1] 张广涛[1] 牟江宁 张超[1] 吴鹏[1] 包振虎 王红燕[1] 

机构地区：[1]宁夏石嘴山市第二人民医院,宁夏石嘴山753000

出　　处：《宁夏医学杂志》2009年第4期344-346,共3页Ningxia Medical Journal

基　　金：宁夏石嘴山市科技局资助项目(2008-32)

摘　　要：目的探讨后腹腔镜下输尿管切开取石治疗复杂性上尿路结石的技术特点和临床应用价值。方法对收治的20例复杂性上尿路结石(结石梗阻时间长,肾积水重,结石周围形成黏连包裹者)病人行后腹腔镜输尿管切开取石术,其中16例术前曾行体外震波碎石(ESWL)治疗。病程最长达3年,结石直径0.7-3.5cm。术中均放置双"J"管和后腹腔引流管。结果后腹腔镜下完成手术14例,中转开放手术6例。全部病例均治愈。后腹腔镜手术平均住院时间(9.4d)小于中转开放手术(16.3d),P<0.05。随访3-22个月,B超和(或)静脉肾盂造影(IVU)复查结石无复发,原有肾积水减轻或消失。结论后腹腔镜输尿管切开取石术具有创伤小,恢复快,住院时间短及结石复发率低的特点,可作为复杂性上尿路结石的首选术式。Objective To discuss the clinic value and technical rule of retroperitoneoscopic ureterolithotomy （RPUL） for treating complex upper ureteral calculi. Methods 20 patients were enrolled, patients with upper urinary tract calculi with long time obstructive hydronephrosis, with severe adhesion and encapsulation, the course from 3 months to 3 years. 16 cases had experienced unsuccessful extracorporeal shock wave lithotripsy （ESWL） sessions before they underwent RPUL. The median diameter of the stone was 12mm （ min - max 7mm - 35mm）. The double - J stent and the retroperitoneal drain tubes were successfully inserted. Results The operations of RPUL were successfully performed in 14 cases. Only 6 patients were converted to open surgery. The average postoperative hospital stay was 9.4 days in RPUL and 16.3 days of opening operation （P 〈0.05）. During the follow- up period （3 -22 months）, uhrasonography and/or intravenous urography （IVU） examinations showed that hydronephrosis and hydroureterosis were lessened, and no ureteric stricture was found. The upper urinary tract calculi had no recurrence at the follow - up period. Conclusion RPUL is an effective and useful alternative treatment and it can provide single - session clearance of the stones. RPUL has advantages over open surgery of minimal invasiveness, smaller incisions, less pain, shorter convalescence period and shorter hospital stay.

关 键 词：腹腔镜 输尿管切开取石术 上尿路结石 

分 类 号：R699[医药卫生—泌尿科学]