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目的:探讨后腹腔镜下输尿管切开取石术的技术要点及临床价值。方法:采用腹腔镜下腹膜后输尿管切开取石术25例,其中6例于术前行ESWL治疗失败;其余19为初次手术治疗。结石直径4~25mm,平均14mm。多数患者病程大于2个月,最长为10年。25例均缝合输尿管切口并放置双J管。结果:1例因结石退至肾盂后改为开放手术,其余24例手术均获成功;手术时间45~120min,平均60min;除1例发生漏尿,其余术后3~9天拔除腹膜后引流管,术后住院时间6~9天。随访2~13个月,无严重并发症出现。结论:后腹腔镜下输尿管切开取石术是安全有效的治疗输尿管上段结石的微创方法,适用于结石较大,病程较长或其他治疗方法失败者,可部分代替传统开放手术。
Objective: To investigate the technical points and clinical value of retroperitoneoscopic ureterolithotomy. Methods: Laparoscopic retroperitoneal ureterolithotomy in 25 cases, of which 6 cases of preoperative ESWL failed; the remaining 19 for the first surgery. Stone diameter 4 ~ 25mm, an average of 14mm. Most patients with more than 2 months duration, up to 10 years. 25 cases were sutured ureteral incision and placed double J tube. Results: One case was converted to an open operation after the stone was returned to the renal pelvis. The other 24 cases were successfully operated. The operation time was 45 to 120 minutes, an average of 60 minutes. Except 1 case of leakage, the remaining 3 to 9 days after operation, Tube, postoperative hospital stay 6 to 9 days. Followed up for 2 to 13 months, no serious complications occurred. Conclusions: Retroperitoneal laparoscopic ureterolithotomy is a safe and effective minimally invasive method for the treatment of upper ureteral calculi. It is suitable for patients with large stones and longer duration or other treatment failures, which may partially replace the traditional open surgery.