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目的:评价经脐单孔腹腔镜(laparoendoscopicsingle-site surgery,LESS)肾盂输尿管切开取石术治疗肾盂及输尿管上段结石的应用价值。方法:施行经脐LESS肾盂输尿管上段切开取石术24例26侧,男10例,女14例;年龄16～71岁,平均45.3岁;结石直径12～30 mm。左侧9例,右侧13例,双侧2例。其中肾盂结石2例,输尿管上段结石22例。术前有ESWL史4例(均为单侧),行URL治疗失败1例,行URL致输尿管穿孔1例。结果:24例手术均获成功,结石均一次取尽。单侧手术时间65～145 min,平均80 min;2例双侧手术时间分别为205 mim和160 min。术中出血量15～45 ml,平均30 ml。3例合并其它泌尿系疾病者同期手术治疗。术中术后均无严重并发症发生,术后3～4天拔除引流管,5～7天拔除尿管并出院。随访2～8个月,脐部瘢痕不明显,无输尿管狭窄,无结石复发。结论:经脐LESS肾盂输尿管上段切开取石术安全、可行、美容效果佳,值得临床选用。
Objective: To evaluate the value of laparoendoscopicsingle-site surgery (LESS) ureteropelvicolithotomy in the treatment of renal pelvis and upper ureteral calculi. Methods: Twenty-six patients (26 males and 10 females and 14 females) were performed lithotripsy through the Umbilicus LESS. The age ranged from 16 to 71 years with an average of 45.3 years. The diameter of stones was 12 to 30 mm. Left in 9 cases, right in 13 cases, bilateral in 2 cases. Among them, 2 cases of renal pelvis and 22 cases of upper ureteral calculi. Preoperative ESWL history of 4 cases (both unilateral), line URL treatment failed in 1 case, line URL to ureter perforation in 1 case. Results: All the 24 cases were successful and the stones were completely eliminated. Unilateral surgery time 65 ~ 145 min, an average of 80 min; two cases of bilateral surgery time was 205 mim and 160 min. Intraoperative bleeding 15 ~ 45 ml, an average of 30 ml. 3 cases of other urological diseases combined with surgical treatment. No intraoperative and postoperative complications occurred, 3 to 4 days after removal of the drainage tube, remove the catheter 5 to 7 days and discharged. Follow-up 2-8 months, umbilical scar was not obvious, no ureteral stricture, no recurrence of stones. Conclusion: Umbilicus LESS ureteropelvic ureteropelvic lithotomy is safe, feasible and good cosmetic effect, it is worth to clinical use.