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目的:报道我院经腹腔后途径腹腔镜输尿管结石切开取石术经验,探讨该术式治疗输尿管结石的应用价值。方法:分析、总结我院经腹腔后途径腹腔镜治疗输尿管上段(L4以上)结石35例临床资料。其中男21例,女14例,平均年龄42岁,其中输尿管上段结石合并中段结石3例(结石位于髂嵴上缘水平处)、结石直径0.9～2.1cm,平均1.5cm,合并不同程度肾积水8例。结果:35例手术均获成功,手术时间35～160min,平均80min;术中出血量20～160mL,平均70mL。肠道功能恢复时间为10～28h。术后发生尿漏5例,负压吸引管引流24h后愈合拔管,术后5d拔出导尿管,住院时间5～13d,平均6d,20例术后21d拔出双J管,5例尿漏者术后2个月拔出双J管、35例患者出院后随诊3～24个月,B超及静脉尿路造影(IVU)检查证实无明显输尿管切口处狭窄。患侧肾功能与术前对比有明显改善,左侧输尿管上段结石18例,右侧17例,对比两侧未发现对手术时间有明显影响。结论:经腹腔后途径腹腔镜输尿管切开取石术可以替代部分传统开放手术,具有微创的优点,尤其是体外冲击波碎石(ESWL)或者输尿管镜气压弹道碎石(URSL)、经皮肾镜取石术(PCNL)治疗失败,后腹腔镜技术则表现出重要的临床应用价值,是一种非常有效的手术方法。
OBJECTIVE: To report the experience of laparoscopic ureterolithotomy in our hospital after transperitoneal approach to explore the value of the surgical treatment of ureteral calculi. Methods: To analyze and summarize the clinical data of 35 cases of upper ureteral calculi (above L4) treated by laparoscopy in our hospital. There were 21 males and 14 females, with an average age of 42 years. Among them, 3 cases of middle ureteral calculi combined with middle stones (stones located on the upper edge of iliac crest) had a diameter of 0.9-2.1 cm with an average of 1.5 cm. 8 cases of water. Results: All the 35 cases were successful. The operation time was 35 ~ 160min with an average of 80min. The intraoperative blood loss was 20 ~ 160mL with an average of 70mL. Intestinal function recovery time is 10 ~ 28h. Postoperative urinary leakage occurred in 5 cases, negative suction catheter drainage after 24 hours of healing extubation, catheterization 5d after surgery, hospital stay 5 ~ 13d, an average of 6d, 20 cases of 21d after pulling double J tube, 5 cases Urine leakage were pulled out double J tube 2 months after surgery, 35 patients were followed up for 3 to 24 months after discharge, B ultrasound and intravenous urography (IVU) examination confirmed no significant ureteral incision stenosis. Ipsilateral renal function compared with preoperative significantly improved, the left upper ureteral stones in 18 cases, the right side of 17 cases, no contrast on both sides found no significant effect on the operation time. Conclusions: The transperitoneal laparoscopic ureterolithotomy can replace some of the traditional open surgery and has the advantages of minimally invasive surgery, especially ESWL or ureteroscopic pneumatic lithotripsy (URSL), percutaneous nephrolithotomy Retroperitoneal laparoscopic surgery has shown an important clinical value in the treatment of PCNL. It is a very effective surgical method.