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目的:探讨经腹腔途径腹腔镜下治疗复杂性输尿管中上段结石的临床技巧和疗效。方法:回顾性分析50例输尿管中上段结石患者的临床资料,均行彩超、CTU或MRU等影像学检查确诊,其中输尿管上段结石38例,输尿管中段结石12例。18例曾行1~4次ESWL治疗,9例曾行输尿管镜碎石治疗,3例曾行经皮肾镜(PCNL)碎石治疗失败。50例均行经腹腔途径腹腔镜下输尿管切开取石术。结果:50例手术均顺利完成,无中转开放手术者。取出结石大小1~3cm。21例伴有息肉,其中14例较小息肉给予电钩切除,7例较大、蒂宽息肉给予息肉段输尿管切除吻合。切除息肉术后病理检查均为输尿管炎性息肉,输尿管壁慢性炎症。平均手术时间70(50~105)min;平均术中出血量20(10~50)ml。2例出现漏尿者于术后2周和1个月漏尿停止。其余患者术后无明显外科并发症,3~5天拔除引流管,5~7天拔除尿管,术后6~8天顺利出院。术后6~8周拔除双J管。术后随访6个月~3年,2例双J管拔除后逐渐出现腰痛,彩超和IVU示原结石部位狭窄,狭窄段长0.5~1.0cm,行输尿管镜丝状电极内切开术后治愈。余48例彩超及IVU检查显示未见结石残留及吻合处输尿管狭窄发生。结论:经腹腔途径腹腔镜下输尿管切开取石术创伤小,恢复快,并发症少,是治疗复杂性输尿管中上段结石的理想方法。
Objective: To explore the clinical skills and efficacy of trans laparoscopic laparoscopic treatment of complex upper ureteral calculi. Methods: The clinical data of 50 patients with upper ureteral calculi were analyzed retrospectively. All the patients were diagnosed by color Doppler ultrasonography, CTU or MRU. Among them, 38 received upper ureteral calculi and 12 received ureteral calculi. Eighteen patients had ESWL treatment 1 to 4 times, 9 patients had ureteroscopic lithotripsy, 3 patients had percutaneous nephrolithotomy (PCNL) lithotripsy failed. All 50 cases underwent laparoscopic ureterolithotomy via intraperitoneal route. Results: All the 50 surgeries were successfully completed without any transfer of open surgery. Remove the stone size 1 ~ 3cm. 21 cases with polyps, of which 14 cases of smaller polyps to give the hook excision, 7 cases larger, pedicle polyps polyp segment ureteral resection and anastomosis. Pathological examination of polyp removed after surgery were ureteral polyps, ureteral wall chronic inflammation. The average operation time was 70 (50 ~ 105) min. The average blood loss was 20 (10 ~ 50) ml. 2 cases of leakage of urine in 2 weeks after surgery and 1 month to stop leakage of urine. The remaining patients without obvious surgical complications, removal of drainage tube 3 to 5 days, 5 to 7 days removal of the catheter, 6 to 8 days after the successful discharge. After 6 to 8 weeks to remove double J tube. Postoperative follow-up of 6 months to 3 years, 2 cases of double J tube after the gradual emergence of low back pain, color Doppler ultrasound and IVU showed the original site of stenosis, stenosis length 0.5 ~ 1.0cm, ureteroscopic wire electrode incision cured . More than 48 cases of ultrasonography and IVU examination showed no residual stones and anastomotic ureteral stricture occurred. Conclusion: Laparoscopic laparoscopic ureterolithotomy has the advantages of less trauma, faster recovery and fewer complications. It is an ideal method for the treatment of complex upper ureteral calculi.