基于层面解剖的后腹腔镜输尿管切开取石术的疗效研究  

Study on the curative effect of retroperitoneal laparoscopic ureterolithotomy based on layer anatomy

作　　者：赵学良 ZHAO Xue-liang(Department of Urology Surgery,Chinese Medicine Hospital of Bozhou,Bozhou 236800,China)

机构地区：[1]亳州市中医院泌尿外科,安徽亳州236800

出　　处：《腹腔镜外科杂志》2022年第6期459-465,共7页Journal of Laparoscopic Surgery

摘　　要：目的:探讨基于层面解剖的后腹腔镜输尿管切开取石术治疗输尿管上段结石的临床效果。方法:回顾分析80例输尿管结石患者的临床资料,分别基于层面解剖行后腹腔镜输尿管切开取石术(实验组,n=40)与常规后腹腔镜输尿管切开取石术(对照组,n=40),观察两组手术时间、术中出血量、术中腹膜与大血管损伤、术后24 h引流量、术后下床活动时间、术后感染与尿瘘、住院时间、术后疼痛及止痛剂应用情况。术后随访3个月,观察输尿管狭窄情况。结果:80例手术均获成功。实验组手术时间、术中出血、并发症发生率、术后24 h引流量、下床活动时间、疼痛评分、止痛剂应用及住院时间优于对照组,差异有统计学意义(P<0.05);实验组未发生感染、尿瘘,对照组发生2例感染、3例尿瘘。术后随访3个月,对照组发生输尿管狭窄3例,两组差异有统计学意义(P<0.05)。结论:基于层面解剖的后腹腔镜输尿管切开取石术具有解剖层次清晰、层面安全、容易游离、术中出血少、术后康复快等优点,值得临床推广。Objective:To investigate the clinical outcomes of retroperitoneal laparoscopic ureterolithotomy based on layer anatomy for upper ureteral calculi.Methods:Clinical data of 80 patients with ureteral stones were retrospectively analyzed.The retroperitoneal laparoscopic ureterolithotomy based on layer anatomy(40 cases in the experimental group)and the conventional retroperitoneal laparoscopic ureterolithotomy(40 cases in the control group)were performed,respectively.The operation time,intraoperative blood loss,intraoperative peritoneum and great vessels injury,drainage volume assessed 24 h after surgery,ambulation time after operation,postoperative infection and urinary fistula,hospital stay,postoperative pain,application of analgesics of the two groups were observed.Patients were followed up for 3 months to observe the ureteral strictures.Results:Eighty operations were successful.The experimental group was significantly better than the control group in terms of operative time,intraoperative blood loss,intraoperative complications,drainage volume at 24 h after surgery,ambulation time,pain score,application of analgesic agents,and hospital stay(P<0.05).Infection and urinary fistula did not occur in the experimental group,while 2 infections and 3 urinary fistulas occurred in the control group,3 ureteral strictures occurred in the control group during the 3-month follow-up,the difference was significant between the two groups(P<0.05).Conclusions:Retroperitoneal laparoscopic ureterolithotomy based on layer anatomy has the advantages of clear anatomical structure,which provides the convenience and safety of anatomical operation,few intraoperative blood loss,and rapid postoperative recovery.This procedure is safe and feasible,and deserves clinical promotion.

关 键 词：输尿管结石 输尿管切开取石术 腹腔镜检查 腹膜后路径 层面解剖 

分 类 号：R693.4[医药卫生—泌尿科学]