后腹腔镜切开取石治疗肾盂输尿管上段结石并重度肾积水

摘要

[ Objective ] To evaluate the feasibility and surgical techniques of retroperitoneoscopic pyelolithotmy (RPPL) and ureterolithotomy (RPUL) for renal pelvis and upper ureteral calculus complicated with severe hy-dronephrosis. [Methods] RPPL or RPUL was performed in 21 cases. Of the 21 cases, 3 cases had pelvis calculus and 18 upper ureteral stone. 1 pelvis and 2 ureteral stone located anterior or interior to aorta/vena cava. Calculi in all cases were complicated with severe hydronephrosis before surgery, of which 5 with huge hydronephrosis and 3 with pyonephrosis. [Results] All of the 21 cases underwent RPPL or RPUL successfully. The operation time ranged from 60 to 220 minutes (mean 100 minutes) , the blood loss ranged from 10 to 100 mL (mean 30 mL). 1 case of calculus complicated with pyonephrosis experienced incision infection postoperatively. Urine leakage happened in 7 cases, last 1 to 7 days. The retroperitoneal drainage tubes were removed 4 to 8 days after operation. During the follow-up period (2-6 months), no ureteric stricture was found, and hydronephrosis was lessened. [Conclusions] RPPL and RPUL are safe, feasible and effective procedures for extra renal pelvis and upper ureteral calculus complicated with severe or huge hydronephrosis and/or with pyonephrosis. In these selected cases, RPPL and RPUL can replace conventional open surgery.%目的 探讨后腹腔镜肾盂输尿管切开取石治疗肾盂输尿管上段结石并重度肾积水的可行性及手术方法.方法 对21例病例采用后腹腔镜治疗,其中肾盂结石3例,输尿管上段结石18例,1例肾盂、2例输尿管结石移位至主动脉或腔静脉的前方或内侧,所有病例合并重度积水,其中5例为巨大肾积水,3例肾积脓.结果 所有21例结石均经后腹腔镜完成.手术时间60～220min,平均100min,出血10 ～ 100mL,平均30 mL.1例肾积脓者术后切口感染,7例术后漏尿1～7 d,腹膜后引流管术后4～8d拔除.术后2～6个月随访,肾积水均不同程度好转,肾盂输尿管未见狭窄.结论 对于长期梗阻导致重度或巨大肾积水和(或)合并肾积脓的肾外型肾盂结石及输尿管上段结石,后腹腔镜切开取石治疗是安全可行而有效的方法,可代替开放手术.