目的 探讨后腹腔镜输尿管切开取石术(retroperitoneal laparoscopic ureterolithotomy,RLU)治疗复杂性输尿管上段结石的疗效和可行性.方法 回顾性分析术前确诊为复杂性输尿管上段结石并行RLU治疗的106例患者的临床资料.结果 106例患者均一次性取石成功,手术时间40～140min,平均(61±24)min,出血量10～80ml,平均(30±12)ml.术中同时处理结石下端输尿管迂曲畸形34例,输尿管局部增厚粘连或息肉增生49例.术后3个月复查B超示同侧肾积水消失或较术前明显减轻.所有患者均获随访,时间3～24个月,平均(12±4.5)个月,均无结石复发或其他严重并发症发生.结论 RLU治疗复杂性输尿管上段结石具有疗效确切、取石率高、创伤小、并发症少、术后恢复快等优点,并可同时处理输尿管其他病变.对于不适于行体外冲击波碎石(ESWL)、腔内碎石等或治疗失败的复杂性输尿管上段结石可作为首选治疗方法.%Objective To investigate the efficacy and feasibility of retroperitoneal laparoscopic ureterolithotomy( RLU )in the treatment of refractory upper ureteral calculi. Methods The clinical data of 106 cases of refractory upper ureteral calculi patients who underwent RLU, from September 2005 to January 2012,were retrospectively analyzed. Results All the 106 cases underwent RLU successfully. The mean operation time was( 61 ±24 )min,ranged from 40 to 140 min. The average volume of blood loss was( 30 ± 12 )ml,ranged from 10 to 80 ml. During the operations,we dealed with 34 cases of ureteral deformities and 49 cases of ureteral hyperplasia or polyps simultaneously. B ultrasound after 3 months of operation showed the hydronephrosis disappeared or significantly reduced compared with the preoperative status. All the patients were followed up for 3 to 24 months( mean, 12 ±4. 5 months ),during which none stone recurrence or other serious complications were appeared. Conclusion RLU is safe, effective and minimally invasive modality of treating refractory upper ureteral calculi and can deal with other diseases of ureters simultaneously. It can be used as the first choice for refractory upper ureteral calculi that ESWL and endoscopic litho-tripsy fail to settled.
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