中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2008年
4期
227-229
,共3页
周辉霞%马鑫%张旭%李爽%张国玺%王保军%史涛平%居正华%王超
週輝霞%馬鑫%張旭%李爽%張國璽%王保軍%史濤平%居正華%王超
주휘하%마흠%장욱%리상%장국새%왕보군%사도평%거정화%왕초
外科手术,腹腔镜%输尿管结石%儿童
外科手術,腹腔鏡%輸尿管結石%兒童
외과수술,복강경%수뇨관결석%인동
Surgical procedures,laparoscopic%Ureteral calculi%Child
目的 探讨小儿后腹腔镜输尿管切开取石术的技术要点及临床应用价值.方法 采用后腹腔镜技术行4qL输尿管切开取石术16例,其中9例分别于术前行体外冲击波碎石术(ESWL)、输尿管镜取石术(URL)或二者结合而失败,7例术前未行其他治疗;结石直径1.2～2.2 cm,平均(1.62±0.35)cm.输尿管上段结石12例,输尿管中段结石4例,右侧4例,左侧12例,男11例,女5例.年龄3～14岁,平均7岁.结果 16例患儿取石均成功.手术时间40～150 min,平均(61.31±29.51)min,术中出血量5～25 ml,平均(12.19±7.06)ml;术中无脏器损伤及气体栓塞等严重并发症.患儿均于术后1～2 d恢复饮食和下床活动.3～5 d拔引流管,1周出院,术后漏尿1例.平均随访8个月(3～36个月),患儿肾输尿管积水均明显好转,无结石复发和输尿管吻合处狭窄.结论 小儿后腹腔镜输尿管切开取石术是安全有效的方法,可部分代替传统开放性手术,对于较大的输尿管上段结石可作为首选的治疗方法.
目的 探討小兒後腹腔鏡輸尿管切開取石術的技術要點及臨床應用價值.方法 採用後腹腔鏡技術行4qL輸尿管切開取石術16例,其中9例分彆于術前行體外遲擊波碎石術(ESWL)、輸尿管鏡取石術(URL)或二者結閤而失敗,7例術前未行其他治療;結石直徑1.2～2.2 cm,平均(1.62±0.35)cm.輸尿管上段結石12例,輸尿管中段結石4例,右側4例,左側12例,男11例,女5例.年齡3～14歲,平均7歲.結果 16例患兒取石均成功.手術時間40～150 min,平均(61.31±29.51)min,術中齣血量5～25 ml,平均(12.19±7.06)ml;術中無髒器損傷及氣體栓塞等嚴重併髮癥.患兒均于術後1～2 d恢複飲食和下床活動.3～5 d拔引流管,1週齣院,術後漏尿1例.平均隨訪8箇月(3～36箇月),患兒腎輸尿管積水均明顯好轉,無結石複髮和輸尿管吻閤處狹窄.結論 小兒後腹腔鏡輸尿管切開取石術是安全有效的方法,可部分代替傳統開放性手術,對于較大的輸尿管上段結石可作為首選的治療方法.
목적 탐토소인후복강경수뇨관절개취석술적기술요점급림상응용개치.방법 채용후복강경기술행4qL수뇨관절개취석술16례,기중9례분별우술전행체외충격파쇄석술(ESWL)、수뇨관경취석술(URL)혹이자결합이실패,7례술전미행기타치료;결석직경1.2～2.2 cm,평균(1.62±0.35)cm.수뇨관상단결석12례,수뇨관중단결석4례,우측4례,좌측12례,남11례,녀5례.년령3～14세,평균7세.결과 16례환인취석균성공.수술시간40～150 min,평균(61.31±29.51)min,술중출혈량5～25 ml,평균(12.19±7.06)ml;술중무장기손상급기체전새등엄중병발증.환인균우술후1～2 d회복음식화하상활동.3～5 d발인류관,1주출원,술후루뇨1례.평균수방8개월(3～36개월),환인신수뇨관적수균명현호전,무결석복발화수뇨관문합처협착.결론 소인후복강경수뇨관절개취석술시안전유효적방법,가부분대체전통개방성수술,대우교대적수뇨관상단결석가작위수선적치료방법.
Objective To present the technical details of retroperitoneoscopic ureterolithotomy in children and evaluate its clinical effects.Methods Between March 2004 and March 2007,16 children with ureteric calculus underwent retroperitoneoscopic ureterolithotomy.Nine cases were as a salvage procedure after unsuccessful ESWL,ureteroscopy or both,while the other 7 cases as a primary procedure.The stone size ranged from 1.2 cm to 2.2 tin(mean 1.62±0.35 cm)with the incarceration time from 1 month to 2 years.Results All cases underwent retroperitoneoscopic ureterolithotomy successfully,the operation time ranged from 41)to 150 minutes(mean 61.31±29.51 minutes),theblood loss ranged from 5 to 25 ml(mean 1 2.1 9±7.06 m1).Postoperative urinary leakage occurred in1 patient.but disappeared at the 3rd day after surgery.During the follow-up period of 16 cases,there was no ureteric stricture or recurrent calculus,and renal function of all these children had been improved.Conclusions Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive procedure for children with ureteric calculus.it can partly take place of conventional open surgery.
