后腹腔镜输尿管切开取石术治疗复杂性输尿管上段结石  

Retroperitoneal Laparoscopic Ureterolithotomy for Complex Proximal Ureteral Calculi:20 Cases Report

作　　者：杨先俊 陈崯 朱建伟 马继涛 YANG Xian-jun;CHEN Yin;ZHU Jian-wei;MA Ji-tao(Department of Urology,Pukou Branch of Jiangsu Provincial People's Hospital,Nanjing 211800,Jiangsu,China)

机构地区：[1]江苏省人民医院浦口分院泌尿外科,江苏南京211800

出　　处：《中国现代手术学杂志》2020年第6期433-436,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨经后腹腔镜输尿管切开取石术治疗复杂性输尿管上段结石的手术技巧及临床效果。方法回顾性分析2018年6月至2019年12月行后腹腔镜输尿管切开取石术的20例患者的临床资料。结石位于左侧14例,右侧6例;输尿管上段多发结石2例,单发18例;结石最大径1.2~3.1 cm。合并肾内有临床意义结石9例,同侧单纯性肾囊肿(>40 mm)2例。结果本组20例患者手术均获成功,手术时间平均82.6(58~160)min,出血量平均45(20~80)ml,术后复查KUB或泌尿系CT平扫均未见结石残留,一期结石清除率达100%,无周围器官损伤,无大出血、气胸、腹膜后感染等并发症。1例术后出现漏尿,未做特殊处理,术后2周漏尿停止后拔除引流管。术后1~2月膀胱镜下拔除双J管。随访6~18个月,均无结石复发和输尿管狭窄发生,所有患者术后肾功能及肾积水均不同程度改善。结论后腹腔镜输尿管切开取石术安全有效,具有创伤小、恢复快、并发症少、病人满意度高等优点,是处理复杂性输尿管上段结石的重要治疗手段。术中以输尿管结石位置确定输尿管分离平面,如出现结石漂移或合并存在肾内有临床意义结石需一并处理时,可联合应用输尿管硬镜碎石取石。Objective To explore the surgical skills and efficacy of retroperitoneal laparoscopic ureterolithotomy for complex upper ureteral calculi.Methods Retrospective analysis was performed on the clinical data of 20 patients with complex upper ureteral calculi underwent retroperitoneal laparoscopic ureterolithotomy from June 2018 to December 2019.The stones located in left lateral in 14 cases and right lateral in 6 cases,and sized from 1.2 to 3.1 cm.9 cases were complicated with renal stone,and 2 cases with simple renal cyst(>40 mm).Results All the operations were successful with the surgical time of 58 to 160 min and the blood loss volume of 20 to 80 ml.No residual stones were found by KUB or CT after the surgery,and the first stage calculi clearance rate was 100%.There was no severe post-operative complication as hemorrhage,pneumothorax and retroperitoneal infection.Urine leakage was found in one case and healed 2 weeks after the surgery without special treatment,and following the drainage tube was removed.Double-J tube was removed under cystoscope during 1 to 2 months after the surgery.After 6 to 18 months follow-up,renal function and hydronephrosis was improved in all patients without ureteral stricture and calculi recurrence.Conclusions Retroperitoneal laparoscopic ureterolithotomy is a safe and effective treatment with less trauma,rapid recovery,fewer complications and higher patient satisfaction,and can play an important role for complex proximal ureteral calculi.During the operation,the ureteral separation plane is determined by the location of ureteral calculi;Rigid ureteroscopic lithotripsy can be used when calculi slipped into kidney or combine with clinical significance renal calculi.

关 键 词：后腹腔镜手术 输尿管结石 上段 输尿管镜检查 

分 类 号：R693.4[医药卫生—泌尿科学]