医学论文-后腹腔镜输尿管切开取石术.docVIP

医学论文-后腹腔镜输尿管切开取石术 【关键词】? 输尿管切开取石术 　　王勤章，丁国富，李令勋，张国玺，倪钊，李应龙，王新敏，谢顺明 　　Retroperitoneal laparoscopic ureterolithotomy (report of 31 cases) 　　ABSTRACT: Objective? To investigate the clinical significance and methods of retroperitoneal laparoscopic ureterolithotomy. Methods? Retroperitoneal laparoscopic ureterolithotomy was performed on 31 patients of ureterolith, the stone size ranging from 0.8-2.5cm in diameter with the duration from 2 months to 3 years. Of the patients, 4 cases was of multiple stones and 27 with single stone, and 19 had undergone unsuccessful ESWL, ureteroscopy or both. Results? All 31 cases succeeded uneventfully. The mean operation time was 105 minutes (55-240min), and the estimated blood loss 10-60mL with a mean of 25mL. The postoperative hospital stay was 7-18d with a mean of 8.7d. There was no serious complications in perioperative and postoperative period. During the 2-24 months followup of 18 cases, the patients renal function had been improved with no ureteric stricture. Conclousion? Retroperitoneal laparoscopic ureterolithotomy has the advantages of minimal invasion, safe, effective and quicker recovery. It can take the place of conventional open surgery in part, but the indications should be controlled strictly. 　　KEY WORDS: laparoscopy; ureteral calculi 　　摘要：目的? 探讨后腹腔镜输尿管切开取石术的方法和临床价值。 方法? 采用后腹腔镜技术行输尿管切开取石术31例，结石直径0.8-2.5cm，病程2个月-3年，4例多发结石，27例单发结石，其中19例曾行ESWL和/或输尿管镜失败。结果? 手术全部成功，无改开放手术者。手术时间55-240min(平均105min)，术中出血10-60mL(平均25mL)，患者均于术后18-24h下床活动，术后住院时间7-18d(平均8.7d)，术中、术后无明显并发症。18例随访2-24个月，肾功能均有不同程度改善，无输尿管狭窄。结论? 后腹腔镜输尿管切开取石术具有微创、安全有效、术后恢复快等优点，可部分替代传统开放手术，但应严格把握适应证。 　　关键词：腹腔镜；输尿管结石 　　自2002年8月至2004年11月我们采用后腹腔镜技术行输尿管切开取石术31例，均一次成功，效果满意，报告如下。 　　1? 资料与方法 　　1.1? 临床资料? 　　输尿管上段结石患者31例，男19例，女12例，年龄21-62岁，平均37岁；左侧18例，右侧13例；多发结石 4例(共11枚 )，单发27例；结石大小0.8-2.5cm，结石滞留时间2月-3年，平均6.2月。3例并发同侧肾盏内多发小结石，1例并发对侧肾盏内小结石。所有患者术前均经B超、IVU、腹部平片(KUB)及逆行肾盂造影或磁共振尿路成像(MRU)证实为阳性结石，结石上方输尿管及肾盂均有不同程度的扩张积水，其中19例曾行体外冲击波碎石(ESWL)、输尿管镜气压弹道碎石术或两者联合治疗失败。 　　1.2? 手术方法 　　1.2.1? 建立工作空间和通道