经腹入路腹腔镜输尿管切开取石术治疗复杂性输尿管中下段结石的临床体会  

Clinical experience of transabdominal laparoscopic ureterolithotomy in the treatment of complex middle and lower ureteral calculi

作　　者：吴万文[1] 吕蔡[1] 刘振湘[1] 白志明[1] WU Wan-wen;LV Cai;LIU Zhen-xiang(Department of Urology,Central South University Xiangya School of Medicine Affiliated Haikou Hospital,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院泌尿外科,海南海口570208

出　　处：《腹腔镜外科杂志》2020年第6期464-466,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨经腹入路腹腔镜输尿管切开取石术治疗复杂性输尿管中下段结石的临床效果。方法:回顾分析2016年10月至2018年10月因复杂性输尿管中下段结石行腹腔镜输尿管切开取石术的76例患者的临床资料,复杂性结石的定义满足以下条件之一:结石长径>1.5 cm且病史>1个月;体外碎石或输尿管镜治疗失败;双侧结石;多发结石。结果:76例手术均由同一组医师完成,无中转开放。手术时间平均(51.3±15.6)min;术中出血量平均(24.6±5.8)mL;术后引流管拔除时间平均(2.7±1.2)d;术后疼痛评分平均(1.8±0.4)分;术后平均住院(4.5±1.8)d。术后KUB平片均显示无结石残留。术后发生漏尿3例,无尿路感染、继发出血等其他并发症发生。术后随访(9.7±2.3)个月,肾积水均较术前减轻。结论:经腹入路腹腔镜输尿管切开取石术安全、有效,是治疗复杂性输尿管中下段结石的可靠方法。Objective:To investigate the efficacy of laparoscopic transperitoneal ureterolithotomy for complex middle and lower ureteral calculi.Methods:The clinical data of 76 patients with complex middle or lower ureteral calculi who underwent laparoscopic transperitoneal ureterolithotomy from Oct.2016 to Oct.2018 were retrospectively analyzed.The definition of complex calculi should meet one of the following conditions:long diameter of the stone up to 1.5 cm and the medical history beyond 1 month;failure of extracorporeal lithotripsy or ureteroscopy;bilateral stones;multiple stones.Results:Seventy-six patients were successfully operated by the same group of surgeons with no conversion to laparotomy.The operative time was(51.3±15.6)min,the operative bleeding volume was(24.6±5.8)mL,the postoperative drainage tube was removed after(2.7±1.2)d;postoperative pain score was(1.8±0.4)and the postoperative hospital stay was(4.5±1.8)d.KUB plain films were taken after surgery,and no stones remained.Three cases had postoperative urinary leakage.There were no urinary tract infection or secondary hemorrhage.All patients were followed up for(9.7±2.3)months,and all patients had less renal hydronephrosis than before.Conclusions:Laparoscopic ureterolithotomy is safe and effective,and it is a reliable method for the treatment of complex middle and lower ureteral calculi.

关 键 词：输尿管结石 复杂性 输尿管切开取石术 腹腔镜检查 治疗结果 

分 类 号：R693+.4[医药卫生—泌尿科学]