后腹腔镜输尿管切开取石术治疗困难的输尿管中上段结石  

Retroperitoneoscopic Ureterolithotomy for Refractory Upper Ureteral Calculi:Report of 51 Cases

作　　者：田生平[1] 许汉标[1] 杨伟忠[1] 杨海超[1] 晏继银[1] 

机构地区：[1]广东省惠州市第三人民医院泌尿外科,惠州516002

出　　处：《中国微创外科杂志》2011年第8期715-717,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨后腹腔镜输尿管切开取石术在治疗困难的输尿管结石中的临床效果。方法 2006年6月～2010年6月,对51例困难的输尿管中上段结石行后腹腔镜输尿管切开取石术。结石位于中段6例,上段45例,结石长径15～30mm。患侧均伴有不同程度的肾盂积水,轻度10例,中度35例,重度6例。术前26例有ESWL史7,例有输尿管镜碎石史。经后腹腔操作,分离出输尿管中上段,用尖刀或电钩切开输尿管并取出结石,通过trocar留置双J管并间断缝合输尿管切口。结果 51例手术均取得成功。手术时间55～200 min,平均90 min,出血量10～100 ml,平均30 ml。无感染、尿漏等并发症。术后住院3～9 d,平均6 d。术后复查KUB及B超无结石残留。随访6～12个月,B超示39例肾积水消失,12例中度积水,无输尿管狭窄和结石复发。结论后腹腔镜输尿管切开取石术治疗输尿管中上段结石效果确切,创伤小,并发症少,可作为ESWL和腔内碎石等治疗方法失败的难治性输尿管结石的首选方法。Objective To discuss the clinical effect of retroperitoneal laparoscopic ureterolithotomy.MethodsRetroperitoneal laparoscopic ureterolithotomy was performed on 51 patients with upper-mid ureteral stones from June 2006 to June 2010.Among the cases,6 patients suffered from stones in the middle ureter,45 had the stones in the upper ureter.The stones were 15-30 mm in longer diameter.All the cases were complicated with various degrees of hydronephrosis,including 10 cases of mild,35 cases of moderate,and 6 cases of severe;26 of the cases had undergone ESWL before retroperitoneal laparoscopic ureterolithotomy and 7 cases had undergone ureteroscopic lithotripsy.By retroperitoneal operation,the upper-mid ureter was separated,and the stone was removed after the ureter was cut with sticker or hypercator.Double-J tube was indwelt through a trocar during the operation.The incision of the ureter was sutured interruptedly.Results All the operations were successfully done without complications such as infection or urine leakage.The mean operation time was 90 minutes（55-200 minutes）,the average blood loss was 30 ml（10-100 ml）,and the mean hospital stay was 6 days（3-9 days） after the operation.Post-operation KUB and ultrasonography showed that all the stones were removed.A 6-to 12-month follow-up showed hydronephrosis in 39 cases disappeared and moderate hydronephrosis remained in the other 12 cases;no recurrent calculi or ureteral stricture occurred.Conclusions Retroperitoneal laparoscopic ureterolithotomy is effective and less invasive with fewer complications.It can be used as the first choice for refractory ureteral stones that ESWL and endoscopic lithotripsy fail to fix.

关 键 词：腹腔镜 切开取石术 输尿管结石 

分 类 号：R699[医药卫生—泌尿科学]