摘要
目的探讨后腹腔镜输尿管上段切开取石术的临床价值.方法采用后腹腔镜技术行输尿管上段切开取石术22例,经后腹腔操作,分离出上段输尿管和结石,用尖刀切开输尿管取出结石,常规在输尿管内置入支架管并缝合输尿管切口.结果1例因结石进入肾内术中改开放手术,1例术后出现持续漏尿500～800 ml/d,3d后改开放手术放置双J管治愈出院.余20例手术均获成功,手术时间50～240 min,平均110 min.术中出血量30～100 ml,平均50 ml.肠功能恢复时间12～30 h,平均18 h.术后住院5～8 d,平均6.8 d.手术成功的20例随访1～12个月,平均5.8月,B超及IVU复查,15例肾盂积水消失,5例轻度肾盂积水,无结石残余及输尿管狭窄.结论后腹腔镜输尿管切开取石术是安全有效的治疗输尿管上段结石的方法,具有创伤小,恢复快等特点,对于较大的输尿管上段结石可作为首选的治疗方法.
Objective To evaluate the clinical significance of retroperitoneoscopic ureterolithotomy for upper ureteral calculi. Methods Retroperitoneoscopic ureterolithotomy was carried out in 22 patients with upper ureteral calculi. The operation was performed in the retroperitoneal space. After the upper ureter and calculi were exposed, a scalpel was utilized to cut the ureter longitudinally for the removal of calculi. A double-J tube was inserted into the ureter routinely and the ureterotomy closure was performed with sutures. Results A conversion to open surgery was needed in 1 patient because the calculi had moved into the kidney. One patient experienced urinary leakage at 500-800 ml/d postoperatively, and received an open surgery of double-J tube insertion 3 days later. Of the remaining 20 patients, the procedure was successfully accomplished, with the operation time of 50-240 min （mean, 110 min） and the blood loss of 30-100 ml （mean, 50 ml）. The time to the recovery of intestinal functions was 12-30 h （mean, 18 h）. The postoperative hospital stay was 5-8 days （mean, 6. 8 days）. Follow-up with B-ultrasonography and intravenous urethrography for 1-12 months in the 20 patients found no residual calculi or ureteral stricture. Hydronephrosis disappeared in 15 patients and mild hydronephrosis was detected in the rest of 5 patients. Conclusions Retroperitoneoscopic ureterolithotomy is a safe and effective option for upper ureteral calculi. It may be considered as the first-line treatment for relatively large-sized upper ureteral calculi.
出处
《中国微创外科杂志》
CSCD
2005年第9期772-773,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
输尿管结石
切开取石术
Laparoscopy
Ureteral calculus
Retroperitoneum
