摘要
目的总结经腹腹腔镜治疗输尿管上段结石经验，探讨其在输尿管嵌顿结石治疗中的价值。方法1999年9月至2012年2月共收治1171例输尿管上段结石患者。其中嵌顿性结石1100例，非嵌顿性结石71例；单侧输尿管多发结石51例；合并同侧肾脏小结石139例。结石最大径0．8～2．6cm，平均1．5cm。均采用经腹腔途径完成腹腔镜输尿管切开取石术，术中留置输尿管支架管及手术部位引流管。结果1171例患者中2例改开放手术；27例结石上移进入肾盂，其中25例改行腹腔镜肾盂切开取石术成功取出结石，2例未能找到结石，留置输尿管支架管后体外碎石治疗，该27例患者均为非嵌顿性结石或输尿管多发结石。其余1142例手术均顺利完成，手术时间26～160min，平均56．1min；术中出血量10～250ml，平均45．2ml；术后引流管拔除时间1—7d，平均3．1d；术后住院时间3～9d，平均4。8d。术后出现漏尿1例，6d后好转；支架管未到位或回缩10例，均于术后经输尿管镜拔除；麻痹性肠梗阻1例，术后1周后好转；术后严重血尿1例，经保守治疗后治愈；未见肠道及邻近脏器损伤、腹腔感染等并发症。827例术后获随访2个月～9年，平均7．3个月，术后输尿管狭窄12例，其中2例为术中发现合并输尿管息肉患者，7例接受输尿管扩张或球囊扩张治疗，3例行输尿管端端吻合，2例失随访；另有5例术前重度肾积水患者术后出现肾脏萎缩，2例无明显症状定期随访，3例因反复腰痛或反复泌尿系统感染接受患肾切除手术。结论经腹腔入路腹腔镜输尿管切开取石术安全可行，结石取净率高，创伤小、恢复快，在输尿管上段嵌顿性结石治疗中可取代开放手术。
Objective To evaluate clinical outcomes and values of transperitoneal laparoscopic ureterolithtomy. Methods A total of 1171 patients with upper ureteral calculi were recruited during September 1999 to February 2012. The etiologies included impacted calculi （ n = 1100 ） , non-impacted calculi （ n = 71 ）, multiple ureteral calculi （ n = 51 ） and combined small calculi in unilateral kidney （ n = 139）. Maximum diameter of calculi was 1.5 （0, 8 -2. 6） era. All patients underwent transperitoncal laparoscopic ureterolithtomy and double J stent was implanted intraoperatively. Results Two cases were converted into open operation. Calculi moving up into pelvis occurred in 27 cases. And 25 cases converted into laparoscopic pyelolithotomy and stones were removed successfully. Two cases received extra extracorporeal shock wave lithotripsy postoperatively. The remaining 1142 cases were treated successfully with an operative duration of 56. 1 （26 - 160） min and an estimated volume of blood loss at 45.2 （10 - 250） ml. The period of drainage tube was 3.1 （ 1 - 7 ） days. Postoperative hospitalization stay was 4. 8 （3- 9 ） days. One patient suffered urine leakage and healed at Day 6 days post-operation. Ten cases suffered D-J stent bladder non-arrival or retraction and double J stents were extracted by ureteroscopy. One case suffered paralytic ileus and recovered 7 days later. Another case suffered severe hematuria. No intestine or adjacent viscera injury was observed. The follow-up period of 827 cases was 7.3 （24 - 108） months. Among 12 cases of ureteral stricture, ureteral dilation （ n = 7 ） and ureteral anastosmosis （ n = 3 ） were performed. For 5 cases of renal atrophy, 3 underwent nephrectomy because of recurrent lumbago or persistent urinary infection. Conclusions Transperitoneal laparoscopic ureterolithotomy has the advantages of minimal morbidity, little postoperative discomfort and high stone clearance rate over open surgery. It should be widelyadopted for the patients with upper ureteral impacted calculi.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第20期1577-1579,共3页
National Medical Journal of China
关键词
输尿管结石
腹腔镜
手术
Ureteral calculi
Laparoscopes
Surgery
