后腹腔镜输尿管切开取石术治疗输尿管上段结石18例临床分析

摘要

Objective To evaluate the treatment of upper ureteral calculi by retroperitoneal laparoscopic ureterolithotomy(RLU). Methods The clinical data of 18 cases(19 ureters)underwent RLU were retrospectively analyzed,the diameters of the calculi varied from 10 to 22 mm,the average was 13.6mm,the courses of the disease of 16 patients were more than 3 months,RLU was carried out in 10 patients af-ter unsuccessful ESWL.All the cuts of ureters were well sutured and D-J tube of 6F were well placed.Results Of all the cases,18 ureters underwent RLU successfully,only 1 ureter converted to open surgery;the time consuming of the operation ranged from 65 to 150 minutes,the average was 82 minutes;the average of the amount of blood loss were 20ml;the time of retaining of the draining tube after operation ranged from 2 to 5 days.D-J tubes were removed 3 to 4 weeks after operation.without complications such as leakage of urine,etc.The postoperative hospital stay was 4 to 9 days.With 3-35 months follow-up,the hydronephrosis relieved,there was no recurrent calculi or ureteric stricture had been found.Conclusions RLU is a safe,reliable and minimally invasive way to treat upper ureteral calculi.%目的：探讨后腹腔镜输尿管切开取石术（RLU ）的方法及临床应用价值。方法回顾性分析采用RLU治疗18例19侧输尿管上段结石患者的临床资料，结石直径10～22 mm，平均13．6 mm，其中16例患者病程大于3个月，10例患者术前行体外冲击波碎石术（ESWL）失败。镜下放置6F双J管并缝合输尿管切口。结果18例19侧手术有1侧中转开放手术，其余18侧均获成功；手术时间65～150 min，平均82 min；术中出血平均20 mL；腹膜后引流管术后2～5天拔除，双J管术后3～4周拔除；无尿漏等并发症发生，术后住院时间4～9 d。随访3～35个月，患侧肾积水好转，无结石复发、输尿管狭窄等并发症出现。结论 RLU是治疗输尿管上段结石安全有效的微创方法。