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[目的]探讨并规范腹腔镜输尿管切开取石术的手术步骤和适应症。[方法]比较33例后腹腔输尿管切开取石术 (LS组)与同期45例开放性输尿管切开取石术(Open组)患者资料、手术时间、费用、术后患侧肾脏功能改变,比较两组的差 别,规范后腹腔镜技术。[结果]两组手术均获成功,成功率为100％。手术时间LS组55～250 min,平均110 min;Open组45～ 135 min,平均65 min(P<0.01)。出血量LS组20～40 mL,平均25 mL;Open组60-165 mL,平均120 mL(P<0.01)。术 后停留尿管时间LS组1～3 d,平均2 d;Open组2～6 d,平均3 d(P>0.05)。腹膜后腔引流管时间LS组1-3 d,平均2 d; Open组3～8 d,平均5 d(P<0.05)。两组术后均留置输尿管内支架管,双J管术后一个月拔除。住院时间LS组5～8 d,平 均6 d;Opec组11～14 d,平均10 d(P<0.05)。并发症LS组早期3例患者尿漏3-6 d自愈,术后使用止痛药(Tramal)剂量 70 mg,康复时间7 d;Open组150 mg,康复时间28 d(P<0.01)。手术费用LS组平均8 000元／人,Open组平均4 350元／ 人(P<0.01)。两组术后肾功能均得到改善。[结论]后腹腔镜输尿管切开取石术微创,安全性、有效性同开放手术相同。可 选择治疗输尿管上段结石。
[Objective] To discuss and standardize the surgical procedures and indications of laparoscopic ureterolithotomy. [Methods] The data of 33 patients with LS and 45 patients with open ureterolithotomy (Open group) during the same period were analyzed retrospectively. The data of operation time, cost and postoperative ipsilateral renal function were compared. Differences between groups, regulating post-laparoscopic techniques. [Results] Both procedures were successful, with a success rate of 100%. The operative time was 55 min to 250 min in LS group, with an average of 110 min and 45 min to 135 min in Open group, with an average of 65 min (P <0.01). The amount of bleeding in the LS group was 20-40 mL (mean 25 mL), while the Open group was 60-165 mL (average, 120 mL, P <0.01). The duration of postoperative ureteral catheterization was 1 to 3 days in LS group, with an average of 2 days. In Open group, it was 2 to 6 days with an average of 3 days (P> 0.05). Retroperitoneal drainage tube time LS group 1-3 d, an average of 2 d; Open group 3 ~ 8 d, an average of 5 d (P <0.05). Two groups of ureter stent were placed after surgery, double J tube removed one month after surgery. The duration of hospitalization was 5 to 8 days in LS group, with an average of 6 days. The Opec group had an average of 10 days (P <0.05) in 11 to 14 days. In the early LS group, the urine leakage was self-healing in 3-6 days. The dose of Tramal was 70 mg and the recovery time was 7 days. The Open group had 150 mg and the recovery time was 28 days (P <0.01). The average cost of surgery was 8 000 yuan in LS group and 4 350 yuan in Open group (P <0.01). Both groups of postoperative renal function have been improved. [Conclusion] The minimally invasive retroperitoneal laparoscopic ureterolithotomy has the same safety and effectiveness as open surgery. Optional treatment of upper ureteral stones.