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目的:探讨腹腔镜输尿管切开取石术的手术技巧及常见并发症的处理。方法:回顾性分析2005～2010年间,在我科行腹腔镜输尿管上段切开取石术的89例患者资料,其中15例之前行输尿管镜碎石失败,22例行ESWL失败,其他52例结石大于1.5cm,伴有中到重度肾积水,其中3例孤立肾结石平均大小1.7cm。均经腹腔途径,保留双J管,间断缝合输尿管。结果:无中转开放,86例取出结石,结石清除率96.6%,3例结石漂移,其中1例最终未能处理,2例在输尿管软镜辅助下取出结石。3例患者发生尿漏,均保持引流通畅后自愈,1例严重血尿,保守治疗后缓解。结论:腹腔镜输尿管切开取石术是体外冲击波碎石和输尿管镜碎石术失败后的有效补救术式,也可以作为较大的(>1.5cm)、积水显著的嵌顿结石尤其是孤立肾结石的首选术式,结石清除率高,也较为更安全。
Objective: To investigate the surgical technique and common complications of laparoscopic ureterolithotomy. Methods: A retrospective analysis of 89 patients with laparoscopic ureterolithotomy in our department between 2005 and 2010 was performed. Among them, 15 cases had unsuccessful ureteroscopic lithotripsy, 22 failed ESWL and 52 cases had more stones 1.5cm, accompanied by moderate to severe hydronephrosis, of which 3 cases of isolated kidney stone average size 1.7cm. Both by abdominal route, retaining double J tube, intermittent suture ureter. Results: There was no transit to open. The stones were removed in 86 cases. The stone clearance rate was 96.6%. Three cases of stone drift. One case was ultimately failed to be treated. Two cases were removed with the aid of ureteroscope. 3 patients with urinary leakage, were to maintain self-healing after drainage and patency, 1 case of severe hematuria, conservative treatment and remission. Conclusions: Laparoscopic ureterolithotomy is an effective remedy after failure of extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy. It can also be used as a large (> 1.5 cm) The preferred method of kidney stones, stone clearance rate is high, but also more secure.