后腹腔镜输尿管切开取石术（附36例报告）

摘要

目的：探讨后腹腔镜技术处理输尿管中上段结石的手术要点与临床应用价值.方法：2009年8月~2013年3月,共施行后腹腔镜输尿管中上段切开取石术36例,其中28例分别于术前行体外冲击波碎石(ESWL)、输尿管镜取石(URL)及微通道经皮肾镜取石术(mPCNL )失败.结石平均长径1．8(1．2~2．8)c m.结果：36例手术均获成功.手术时间65~150 min ,中位数85 min .术中估计失血量15~65 ml,中位数25 ml.术后平均随访10(2~24)个月,无结石复发及输尿管狭窄发生.结论：后腹腔镜输尿管切开取石术可作为ES WL、URL、mPCNL 失败后的有效补救治疗措施,是一种安全、有效的微创手术方法.%Objective:To explore the key technical points and clinical value of retroperitoneoscopic ureterolithoto-my in the treatment of middle or upperureteral calculi.Methods:From August 2009to March 2013,atotalof36pa-tients with middle or upper ureteral calculi were treated with retroperitoneoscopic ureterolithotomy at our institu-tion,amongthem,28 previously accepted ESWL,ureteroscopiclithotripsy (URL)or mini-percutaneous nephrolith-otripsy (mPCNL).The mean stone size was 1 .8 cm (range 1 .2 to 2 .8 ).Results:All cases were successfully operated . There were no major intraoperative and postoperative complications .Median operative ti me was 85 min (range 65 to 150 min).Median esti mated blood loss was 25 mL (range 15 to 65 mL).Mean follow-up period was 10 months (range 2 to 24 months ).No ureteral stricture and recurrent calculi occurred .Conclusions:In view that retroperitoneo-scopic ureterolithotomy is a safe an deffective procedure,it could actasanal ternative remedyint reatingureteral cal-culi after failed ES WL ,URL or mPCNL .