耻骨上辅助经脐微双孔腹腔镜治疗L4平面以下输尿管嵌顿性巨大结石  

The application of suprapubic-assisted umbilical laparoendoscopic mini-dual-site surgery(SAULEMDS)ureterolithotomy for large impacted ureteral stones located in lower than fourth lumbar vertebra

作　　者：罗道升[1] 莫俊华[1] 黄荏钊[1] 莫志锋[1] 张增强[1] 李牧[1] 卢健军 梁镇锋 孟祥军[1] 米其武[1] 

机构地区：[1]东莞市人民医院泌尿外科,广东523059

出　　处：《中华腔镜泌尿外科杂志（电子版）》2015年第4期24-27,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：东莞市社会科技发展项目(2014108101023)

摘　　要：目的 探讨耻骨上辅助经脐微双孔腹腔镜（SAU-LEMDS）治疗第4腰椎平面以下输尿管嵌顿性大结石的安全性、可行性和有效性。方法 自2013年1月至2014年6月,入选患者18例,男12例,女6例,平均年龄46.5（38-72）岁。均为单侧输尿管单发、嵌顿性大结石,其中左侧13例,右侧5例;结石均位于腰4椎体以下,其中上段结石6例,中段结石8例,下段结石4例。结石最大径平均2.6（2.0-4.5）cm。全麻,头低脚高15°截石位,脐缘置入两个5 mm Trocar及操作器械,自耻骨联合健侧阴毛覆盖区置入一5 mm或10 mm Trocar及腹腔镜。手术方法同普通腹腔镜输尿管切开取石术,经尿道逆行留置双J管,结石标本从耻骨上Trocar处延长切口取出。结果 全部手术均成功,平均手术时间85（65-125）min,平均失血量20（15-40）ml,平均住院时间7（6-9）d。术后第3天复查腹部平片（KUB）,结石全部清除。术后1-3个月拔除输尿管内双J管,随访3个月,复查静脉/排泄性尿路造影（IVU）显示输尿管通畅、无狭窄、无尿漏,结石无复发,术后切口愈合良好,手术瘢痕隐蔽,美容效果佳。结论 SAU-LEMDS技术治疗嵌顿性输尿管大结石安全可行,可降低经脐单孔腹腔镜技术（U-LESS）手术难度,且具有良好的美容效果。Objective To describe the initial clinical experiences of suprapubic-assisted umbilical laparoendoscopic mini-dual-site surgery （SAU-LEMDS） ureterolithotomy for large impacted ureteral stones located in lower than fourth lumbar vertebra （IA）, and evaluate its safety, feasibility and efficacy. Eighteen consecutive patients including 12 males and 6 females, with a mean age of 46.5 yeas （range from 38 to 72 years）, were enrolled from January 2013 to June 2014 in our department. All cases were single large impacted ureteral stone including 13 left-sidedness and 5 right-sidedness, with a mean stone maximum diameter of 2.6 cm （range from 2.0 to 4.5 cm）. According to the position of stone in the ureter, the stones in the upper ureter but below the L4 lever were 6/18 cases, 8/16 cases in the middle ureter, 4/18 cases in the dorsal ureter. After the successful endotracheal anesthesia, the patients were positioned in lithotomy position with 15° slope low head and up-feet. Two 5-mm trocars were inserted into the umbilical edge. One 5-mm or 10-mm trocar was inserted into abdominal cavity below the pubic hairline, through which a 5-mm 30° laparoscope was placed. The specimens （stones） were removed through the suprapubic enlarged incisions. All 18 procedures were successfully performed. The mean operative time was 85 minutes （range from 65 to 125 minutes）. The mean blood loss was 20 ml （range from 15 to 40 ml）. The hospitalization duration was between 6 and 9 days with a mean postoperative stay of 7 days. In all cases, all stones were completely removed based on the KUB evaluation at 3 day postoperatively. Double-pigtail ureteral stents were routinely removed in the outpatient clinic approximately 1 to 3 months postoperatively. There were no cases of major complications, including recurrence of ureteral stone, urinary leakage or ureter obstruction on the basis of IVU evaluation at 3 months postoperatively. The cosmetic results were excellent due to the hidden umbilicus scar during follow-up of 3

关 键 词：腹腔镜 经脐途径 耻骨联合 结石 手术 

分 类 号：R699.4[医药卫生—泌尿科学]