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目的探讨应用一个血管夹防止后腹腔镜输尿管切开取石术术中结石移位的临床应用价值。方法 2006年3月至2009年6月共收治输尿管上段结石患者58例,随机分组后所有患者均行后腹腔镜输尿管切开取石术。26例术中采用无损伤血管夹钳夹结石上方输尿管再行输尿管切开取石,32例术中直接切开输尿管取石,两组术中均留置双J管,比较两组的总手术时间、取石时间、术中出血量及术后随访手术疗效。结果 58例手术全部成功,无一例中转开放手术,术中均无输血。两组在手术时间、术中出血量及住院时间上差异均无统计学意义。血管夹组较直接切开取石组取石时间短。两组术后复查均未见结石残留,无并发症发生。结论术中应用血管夹可防止结石向输尿管上方移位,降低取石难度,缩短术中取石时间,有临床应用价值。
Objective To investigate the clinical value of using a vascular clamp to prevent the metastasis of stones during retroperitoneal laparoscopic ureterolithotomy. Methods From March 2006 to June 2009, 58 patients with upper ureteral calculi were treated. All patients underwent randomized laparoscopic ureterolithotomy. Twenty-six cases were treated with non-invasive vascular clamp and ureter above ureteral stone, 32 cases underwent direct ureterolithotomy, and double J tube was placed in both groups. The total operation time was compared between the two groups Time, intraoperative blood loss and postoperative follow-up surgery. Results All the 58 surgeries were successful. None of the surgeries were open surgery and no intraoperative blood transfusion. There was no significant difference in operation time, intraoperative blood loss and hospitalization time between the two groups. The vascular clamp group was shorter than the direct stone removal group. No recurrence of calculus was found in the two groups after operation, and no complication occurred. Conclusion Intraoperative vascular clamp to prevent the stones above the ureter to shift, reducing the difficulty of stone removal, shortening the time of stone removal, the clinical value.