经脐单孔腹腔镜输尿管及肾盂切开取石术18例临床分析  

Transumbilical laparoendoscopic single-site ureterolithotomy and nephrolithotomy:report of 18 cases

作　　者：杨峻峰[1] 肖民辉[1] 何正宇[1] 章卓睿[1] 申杰[1] 肖龙[1] 余闫宏[1] Yang Junfeng Xiao Minhui He Zhengyu Zhang Zhuorui Shen Jie Xiao Long Yu Yanhong(Department of Urology, Yunnan Provincial First People＇ s Hospital, Kunming, Yunnan Province, 650032, Chin)

机构地区：[1]云南省第一人民医院泌尿外科,昆明650032

出　　处：《第三军医大学学报》2017年第1期95-100,共6页Journal of Third Military Medical University

摘　　要：目的探讨经脐单孔腹腔镜下输尿管及肾盂切开取石术的应用。方法 2014年5月至2015年5月,行经脐单孔腹腔镜输尿管及肾盂切开取石术18例21侧,包括男性5例,女性13例,平均年龄35.5岁,均为单发结石,平均最大径为2.5 cm,结石分别位于输尿管上段13枚,中段3枚,下段2枚,肾盂3枚;感染或积脓5例。患侧高70°斜卧位,取脐周"U"形切口约3 cm,置入"1环3通道"装置,30°腹腔镜及普通腹腔镜器械,用改良法置入D-J管后,间断缝合输尿管壁,改良法打结。结果手术均成功完成,单侧手术时间平均97 min,术中平均出血15 m L,术后平均3.5 d出院,术后1~2个月D-J管拔除后影像学复查,未见局部狭窄及结石残留,伤口愈合美观,温哥华疤痕评分平均为2.3分。结论对于较大的、感染性的、复杂的输尿管或肾盂结石,不宜采用输尿管镜或经皮肾镜等微创治疗手段或治疗失败的患者,可选择经脐单孔腹腔镜输尿管或肾盂切开取石术治疗。Objective To investigate the application and operation skills of transumbilical laparoendoscopic single-site ureterolithotomy and nephrolithotomy. Methods Transumbilical laparoendoscopic single-ite ureterolithotomy and nephrolithotomy were performed in 18 patients （21 sides, 5 males and 13 females, at a mean age of 35.5） in our hospital from May 2014 to May 2015. All the stones were solitary calculi, with an average maximum diameter of 2.5 cm. There were 13 stones at the upper of the ureter, 2 stones at the bottom of the ureter, and 3 stones in the middle of the ureter. Five cases had infection or empyema. The patients were in lateral decubitus on the affected side （70°）, and then underwent a periumbilical Ushaped incision of 3 cm in size. Then a 1-ring 3-channel device was inserted for laparoscopy and ordinary laparoscopic instruments. A modified method was used to send D-J tube. The ureter was sutured intermittently, and improved knot tie was used to these surgeries. Results The surgery was successfully completed in all the patients. The average operation time was 97 min. The intraoperative bleeding amount was 15 mL. The average hospital length of stay was 3.5 d after surgery. The D-J stents were pulled out in 1～2 months after surgery, and then imaging reviews were taken. No ureteral and renal pelvis stricture and residual calculi was found. The wound healed well, and the outlook of the umbilical scar got 2.3 points averagely by Vancouver scar scoring. Conclusion For most cases with very large, impacted and multiple pelvic or ureteral stones, and being not suitable for ureteroscopic lithotripsy and percutaneous nephrolithotomy or those unlikely to succeed, transumbilical laparoendoscopic singlesite ureterolithotomy or nephrolithotomy is a good choice. Modified laparoscopic techniques improve the operation efficiency.

关 键 词：经脐单孔腹腔镜 输尿管切开取石术 肾盂切开取石术 

分 类 号：R692.4[医药卫生—泌尿科学] R693.4[医药卫生—外科学]