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目的:探讨腹腔镜下经肠系膜途径行左侧输尿管上段切开取石术的临床经验和疗效。方法:常规制备气腹;进入腹腔后不游离结肠,在腹腔镜下透过肠系膜辨认扩张的肾盂、输尿管,直接在降结肠系膜无血管区开窗,游离输尿管上段,行输尿管切开取石术。采用此术治疗左侧输尿管上段结石患者10例,记录患者的性别、年龄、身体质量指数(BMI)、手术时间、术中出血量、术后恢复饮食时间和下地活动时间、住院时间、术后症状改善以及B超和IVU复查结果。结果:10例手术均获得成功,平均手术时间(56.2±19.5)min,平均术中出血量(28.7±8.1)ml,恢复饮食和下床活动平均时间分别为18 h和12 h;术后平均住院时间6.5天。随访6～42个月,平均24.1个月,临床症状消失,复查B超和静脉肾盂造影(IVU),输尿管无狭窄,肾积水消失或减少,肾功能改善。结论:对体形瘦、肠系膜脂肪少的初次手术患者,经结肠系膜途径行左侧输尿管上段切开取石术安全有效,可以减少创伤,缩短手术时间。
Objective: To investigate the clinical experience and curative effect of laparoscopic trans-mesenteric approach on the left upper ureteral incision and lithotomy. Methods: Conventional preparation of pneumoperitoneum; enter the peritoneal cavity after the free colon, in laparoscopy through the mesentery to identify expansion of the renal pelvis, ureter directly in the descending mesenteric non-vascular area fenestration, the free upper ureter, ureteral incision lithotomy. Ten patients with upper ureteral calculi were treated with this technique. The patient’s gender, age, body mass index (BMI), operation time, intraoperative blood loss, postoperative diet and time, postoperative hospital stay, Symptoms and B-ultrasound and IVU review results. Results: All of the 10 surgeries were successful. The average operation time was 56.2 ± 19.5 min and the average blood loss was 28.7 ± 8.1 ml. The average time for resuming diet and getting out of bed was 18 h and 12 h respectively. Hospitalization time 6.5 days. All the patients were followed up for 6 ~ 42 months with an average of 24.1 months. The clinical symptoms disappeared. The ultrasound and IVU were reviewed. No ureteral stricture, hydronephrosis disappeared or decreased, and renal function improved. CONCLUSIONS: For the first-time patients with thin body and less mesenteric fat, it is safe and effective to cut the upper ureter via the mesocolon route, which can reduce the trauma and shorten the operation time.