腹膜后腹腔镜肾窦内肾盂切开取石术17例报告  

Retroperitoneal laparoscopic pyelolithotomy in renal sinus:a report of 17 cases

作　　者：叶剑青[1] 高轶[1] 张东旭[1] 陈杰[1] 王军凯[1] 干思舜[1] 刘玉杉[1] 徐丹枫[1] 

机构地区：[1]第二军医大学附属长征医院全军泌尿外科中心,上海200003

出　　处：《腹腔镜外科杂志》2013年第3期213-215,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹膜后腹腔镜肾窦内肾盂切开取石术的初步临床经验及手术疗效。方法:回顾分析2009年1月至2012年10月为17例肾结石患者经后腹腔途径行腹腔镜肾窦内肾盂切开取石术的临床资料。其中男14例,女3例;平均(45.6±8.9)岁;结石直径平均(2.6±0.9)cm。结石位于左侧11例、右侧6例,双肾结石4例,合并输尿管结石5例。结果:17例手术均获成功,手术时间平均(121.0±43.1)min,术中出血量平均(67.5±30.8)ml,术后平均住院(5.1±1.7)d,留置双J管4周。平均随访(18.0±6.4)个月,尿路平片及静脉尿路造影提示,2例患者分别于肾下盏残留0.6 cm及0.7 cm结石,余者均无结石残留,无一例肾盂出口输尿管狭窄。结论:腹膜后腹腔镜肾窦内肾盂切开取石术治疗肾结石是可行、安全、有效的。对于需保留肾单位(如孤立肾、单个肾)、严重感染、合并同期上尿路其他病症、不适合经皮肾镜取石的患者,可考虑替代开放手术。Objective：To evaluate the initial experience and therapeutic effect of retroperitoneal laparoscopic pyelolithotomy within renal sinus. Methods：A retrospective analysis was made on clinical data of 17 patients who suffered from kidney calculi and un- derwent retroperitoneal laparoscopic pyelolithotomy within renal sinus from Jan. 2009 to Oct. 2012. There were 14 males and 3 females, the average age was （45.6 ＋-8.9 ） years, the calculi diameter was （2.6 ＋ 0.9 ） cm. 11 cases were in the left, 6 in the right ,4 in both sides. Five cases concomitantly had ureteral calculi. Results：The procedure was successful in all the 17 cases. The mean operative time was （ 121.0 -＋43.1 ） min,blood loss was （67.5 _＋30.8） ml. Postoperative hospital stay was （5.1 _＋ 1.7） d,double-J tube was removed after four weeks. Follow-up time was （18.0 _＋ 6.4） months. Kidney ureter bladder and intravenous urography showed no upper urinary tract stricture and no residual stones except for 1 stone of 0.7 cm and 1 of 0.6 cm in the renal lower calyx in 2 cases. Conclusions ： Ret- roperitoneal laparoscopic pyelolithotomy is a feasible, safe and effective minimally invasive approach for renal calculus. And it can be considered an alternative to open surgery for the patients with single kidney, serious infections, other symptoms of upper urinary tract, and who is not suitable for percutaneous nephrolithotripsy.

关 键 词：肾结石 肾盂切开取石术 腹腔镜检查 腹膜后路径 

分 类 号：R699[医药卫生—泌尿科学]