【摘要】 目的探讨后腹腔镜输尿管上段切开取石术的适应证、操作方法及围手术期处理。方法 2008年10月～2010年5月,对102例输尿管上段结石患者实施后腹腔镜下输尿管切开取石手术,手术路径均为后腹腔径路。术中沿腰大肌寻找、游离出输尿管,确认结石位置后用抓钳于结石近端控制输尿管。电钩纵向切开输尿管取石,置双J管,4-0可吸收线间断缝合输尿管切口,于输尿管旁放置引流管(合并肾囊肿者同时行去顶减压)。结果手术均获成功,手术时间45～130min,平均65min,术中出血量约10～40ml,手术后3d结石清除率100%(102/102)。手术后1～3d拔除引流管,3～5d拔除导尿管,术后4～6d出院,术后平均住院时间5.6d。其中2例患者(女)术后第3天出现漏尿,经留置导尿、中心负压吸引等治疗后于术后第5天愈合。所有患者术后4～12周膀胱镜拔除双J管。随访3～6个月无相关并发症发生。结论后腹腔镜输尿管上段切开取石术治疗嵌顿性结石安全、有效,并可同时处理同侧多种疾病,是治疗输尿管上段结石一种有效微创手段。更多还原

【Abstract】 Objective To explore the indications operative techniques and the perioperative treatments of retroperitoneal laparoscopic ureterolithotomy.Methods From October 2008 to May 2010,102 patients with proximal ureter stone were streated by retroperitoneal laparoscopic ureterolithotomy.Retroperitoneal routine was adopted to all patients.To dissect the ureter on the surface of psoas,controlled the proximal ureter by forcep after verified the location of stone.Electric hook incised ureter and extracted the stone,indwelled double J in ureter,the ureter incision were colsed by 4-0 absorbable suture,indwelled drainage tube in retroperitoneal space(patients with kidney cyst were performed onroofing of the cyst at the same time).Results All the operations were performed successfully,the operative time was 65 minutes(ranged 45 to 130 minutes),blood loss was 10~40ml,the stone clearance rates of 3 days were 100%.The drainage tube was extracted after postoperation 1~3 days,and the urine cather of 3~5 days,the postoperation hospitalization was 4~6 days(mean 5.6 days),leakage of urine was observed in two female patients,5 days later,the patient was fully recovered by using negative aspiration.Postoperation 4~12 weeks,by using cystoscopythe to extract double J.During the follow-up of 3~6 months,any relative complications occured.Conclusion Retroperitoneal laparoscopic ureterolithotomy can treat several lesions simultaneously in a safe and effective way,it is an efficacious measure to treat proximal ureter stone.更多还原