[Objective] To investigate the difficulties of retroperitoneal laparoscopic ureterolithotomy (RLU) for upper ureteral calculi in learning curve. [Methods] Between July 200? and December 2010, 33 cases (25 males and 8 females) consecutive retroperitoneal laparoscopic ureterolithotomies were reviewed by author during the learning curve period in laparoscopy. Patients were divided and into group A (the first 16 patients) and group B (late 17 patients). Timing for ureter isolation, ureteral double J stent placement and ureter suturing were recorded. Intraoper-ative complications and perioperative morbidity were also reported. [Results] There was no statistical difference in stone size between groups [(22.0±5.5) vs. (20.0±5.0) mm, P >0.05]. Significant differences between group A and B were observed m terms of time for access to the operating field [(24.0±6.4) and (10.0±3.7) min, respectively, P < 0.05], time for double J ureteric stent placement [(18.0±7.2) and (8.0±3-7)min, respectively, P <0.05], time for suturing the ureter [(30.0±7.5) and (13-0±3.6) min, respectively, P <0.05]; and total operative time [mean times (116.0± 20.4) and (72.0±12.2) min, respectively, P <0.05]. No statistical differences were observed for any other parameters. Blood loss was minimal in all cases (mean losses 67 and 50 mL, respectively, P >0.05); One patient developed uri—rn nary leakage because of displacement double J ureteric stent. At the 6-month follow-up, I cases of ureteral stricture were recorded in group A. [Conclusions] The operative difficulties were ureter isolation, ureteral double j stent placement and ureter suturing during the learning curve period in RLU. The learning curve of the RLU requires approximately 15 cases to achieve more proficiency.%目的 探讨学习曲线内后腹腔镜输尿管上段切开取石术的手术难点.方法 2007年7月～ 2010年12月由作者完成后腹腔输尿管上段切开取石术33例(男25例,女8例).患者分为前期组(A组)16例和后期组(B组)17例.比较两组输尿管寻找、双J管的植入和输尿管缝合时间及手术并发症.结果 两组患者结石平均大小相近[(22.0±5.5):(20.0±5.0)mm,P ＞0.05],手术出血量相当.A组输尿管寻找时间[(24.0±6.4):(10.0±3.7)min,P ＜0.05]、置入双J管时间(18.0±7.2):(8.0±3.7)min,P ＜0.05]、输尿管缝合时间[(30.0±7.5):(13.0±3.6)min,P ＜0.05]和总手术时间[(116.0±20.4):(72.0±122)min,P ＜0.05]显著多于B组.两组均无1例改行开放手术,A组1例双J管放置不到位发生漏尿,1例术后6个月发生输尿管狭窄.B组无1例并发症发生.结论 输尿管结石的定位寻找和输尿管缝合、双J管的置入是学习后腹腔镜输尿管上段切开取石术的技术难点.后腹腔镜输尿管上段切开取石术学习曲线大约需15例左右经验积累,即可达到较熟练程度.
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