后腹腔镜下肾盂输尿管上段切开取石术20例临床疗效研究.docVIP

后腹腔镜下肾盂输尿管上段切开取石术20例临床疗效研究【摘要】 目的 探讨后腹腔镜下肾盂输尿管上段切开取石术的临床疗效。方法 2006年1月至2009年3月对20例肾盂输尿管上段结石患者,在腹腔镜下经腹膜后行肾盂输尿管切开取石术,其中13例手术前行ESWL治疗无效,7例为初次手术治疗。结石直径12~40 mm。结果 1例因结石退至肾盂后改为开放手术,其余19例成功。手术时间70~280 min,平均90 min。术后全部获得随访,随访5~38个月,平均24个月,无并发症发生。结论 后腹腔镜下肾盂输尿管上段切开取石术,具有安全、创伤小、术后恢复快等优点,可部分代替传统开放手术,对于较大的肾盂输尿管上段结石可作为首选的治疗方法。 【关键词】 腹腔镜;肾盂输尿管上段结石;临床疗效 The clinical effect study of 20 cases retroperitoneoscopic pyelolithotomy and ureterolithotomy GONG Quan-hua,WANG Dong-wen.Shanxi Medical University,Taiyuan 030001,China 【Abstract】 Objective To discuss the clinical effect study of 20 cases retroperitoneoscopic pyelolithotomy and ureterolithotomy.Methods Retroperitoneoscopic pyelolithotomy and ureterolithotomy were carried out 20 cases from Jan.2006 to Mar.2009,13 of whom were treated using this method as a salvage procedure after unsuccessful ESWL,7 of whom as a primary procedure.The stone size ranged from 12-40 mm.5 cases were pyelolithiasis,the other were upper ureterolith.Results Of all the cases,19 patients underwent retroperitoneoscopic operation successfully,only 1 case converted to operation.The operation time ranged from70 to 280 minutes(mean 90 minutes).During the follow-up period with5-38 months(mean 24 months)of all the cases,there was no complication.Conclusion Retroperitoneoscopic pyelolithotomy and ureterolithotomy is a safe and effective minimally invasive procedure and recovers quickly after the operation.It can take the place of conventional open surgery in part,and in selected patients with large chronically impacted upper ureterolith,it may be prior to the treatment of upper ureterolith. 【Key words】 Laparoscopy;Pyelolithiasis;Upper ureterolith;The clinical effect 20世纪90年代腹腔镜技术在泌尿外科得到应用和推广,腹腔镜肾盂输尿管切开取石术部分代替了传统的开放手术[1]。本科于2006年1月至2009年3月对20例肾盂输尿管上段结石,行后腹腔镜下肾盂输尿管切开取石术,并进行了随访,疗效满意,现报告如下。 1 资料与方法 1.1 临床资料 本组共20例,男性患者12例,女性8例,年龄30~63岁,平均42岁。全部术前经B超、KUB、IVP或CT证实为肾盂输尿管上段阳性结石,结石直径12~40 mm。19例伴近端输尿管扩张及肾盂积水,13例术前行ESWL1次或1次以上,7例为初次手术治疗。5例为肾外型肾盂结