后腹腔镜输尿管中上段复杂性结石改良式切开取石的可行性探讨  

Feasibility of retroperitoneal laparoscopic lithotomy for complex upper and middle ureteral calculi

作　　者：刘涛 杨卫臣 张鹏 李猛 孙瑞琦 梁晓根 Liu Tao;Yang Weichen;Zhang Peng;Li Meng;Sun Ruiqi;Liang Xiaogen(Department of Foreign Affairs,China Railway fuyang Central Hospital,Fuyang,Anhui,236000,China)

机构地区：[1]中国中铁阜阳中心医院外一科

出　　处：《当代医学》2020年第5期44-46,共3页Contemporary Medicine

摘　　要：目的探讨后腹腔镜下对输尿管中上段复杂性结石采取改良式切开取石方法的安全性、有效性及实用性。方法回顾性分析2016年12月至2018年9月19例复杂性输尿管中上段结石患者病史资料及手术方式,均采用后腹腔镜下对输尿管中上段复杂性结石改良式切开取石。其中,男13例,女6例。年龄31~71岁,平均(52.3±6.9)岁。左侧13例,右侧6例,结石直径10~31 mm,平均结石直径(16.3±4.2)mm,均伴有不同程度患侧肾积水。2例有同侧肾囊肿,同期行肾囊肿去顶减压术。结果 19例手术均获成功,结石清石率94.7%,其中1例伴随结石直径约0.5 cm大小上移至肾内,4周后随诊拔除双J管时检查发现结石下移至输尿管下段,ESW后拔除双J管,术后8周再次检查彩超结石已排出。随访3~12个月,无漏尿,输尿管狭窄等严重并发症发生。结论后腹腔镜下对输尿管中上段复杂性结石采取改良式切开取石方法具有较高的安全性和取石率,住院时间短,术后恢复快,在临床上仍具有较强的实用性。Objective To investigate the safety, effectiveness and practicability of retroperitoneal laparoscopic lithotomy for complex upper and middle ureteral calculi. Methods Retrospective analysis of 19 cases of complex upper and middle ureteral calculi from December 2016 to September2018 was made. Retroperitoneal laparoscopic modified incision was used to remove complex upper and middle ureteral calculi. Among them, 13 were males and 6 were females. The age ranged from 31 to 71 years, with an average of(52.3±6.9) years. There were 13 cases on the left side and 6 cases on the right side. The diameter of the stones was greater than 10 mm, the largest was 31 mm, the smallest was 10 mm, and the average diameter of the stones was(16.3±4.2) mm. All of them were accompanied by hydronephrosis on the affected side. Two cases had ipsilateral renal cyst, and renal cyst decompression was performed at the same time. Results All the 19 cases were successfully operated. The stone clearance rate was 94.7%. One of them moved up to the kidney with the stone diameter of about 0.5 cm. After 4 weeks of follow-up examination, the stone was removed to the lower ureter. After ESW, the double J tube was removed, and the stone was removed by color Doppler ultrasound again 8 weeks after operation. One case had local retroperitoneal hematoma caused by bleeding during C-hole suture removal after operation, which was improved after symptomatic treatment. During the follow-up period of 3-12 months, no serious complications such as urinary leakage and ureteral stricture occurred. Conclusion Retroperitoneal laparoscopic lithotomy for complex upper and middle ureteral calculi has high safety and stone removal rate, short hospitalization time,quick recovery after operation, and still has strong practicability in clinic.

关 键 词：后腹腔镜 复杂性输尿管中上段结石 输尿管切开取石 改良式 

分 类 号：R699[医药卫生—泌尿科学]