CAJ | 학술논문

目的探讨后腹腔镜输尿管切开取石术治疗输尿管上段结石的手术技巧.方法回顾性分析采用后腹腔镜输尿管切开取石术治疗输尿管上段结石61例患者的临床资料,结石直径6～26mm,平均12.7mm,其中58例患者病程大于2个月.镜下放置5F ～7F输尿管双J管并缝合输尿管切口.结果 61例手术有2例中转开放手术,其余59例均获成功；手术时间 40～135min,平均53min；术中出血平均18ml;腹膜后引流管留置术后1～4天拔除,双J管术后2～4周拔除,无尿漏等并发症发生,术后住院时间4～9天.52例获随访2 ～24个月,所有患侧肾积水好转,无结石复发、输尿管狭窄等并发症出现.结论采用合理的手术技巧,术中快速放置双J管,后腹腔镜输尿管切开取石术损伤小、手术时间较短、术后恢复快、疗效确切,并发症少,是治疗输尿管上段结石可选择的微创方法,对于无腹膜后手术史,结石较大、其他治疗方法失败者可作为首选术式.
목적 탐토후복강경수뇨관절개취석술치료수뇨관상단결석적수술기교.방법 회고성분석채용후복강경수뇨관절개취석술치료수뇨관상단결석61례환자적림상자료,결석직경6～26mm,평균12.7mm,기중58례환자병정대우2개월.경하방치5F ～7F수뇨관쌍J관병봉합수뇨관절구.결과 61례수술유2례중전개방수술,기여59례균획성공；수술시간 40～135min,평균53min；술중출혈평균18ml;복막후인류관류치술후1～4천발제,쌍J관술후2～4주발제,무뇨루등병발증발생,술후주원시간4～9천.52례획수방2 ～24개월,소유환측신적수호전,무결석복발、수뇨관협착등병발증출현.결론 채용합리적수술기교,술중쾌속방치쌍J관,후복강경수뇨관절개취석술손상소、수술시간교단、술후회복쾌、료효학절,병발증소,시치료수뇨관상단결석가선택적미창방법,대우무복막후수술사,결석교대、기타치료방법실패자가작위수선술식.
Objectives To summarize the technical detail of retroperitoneal laparoscopic ureterolithotomy (RLU) for upperureteric calculi.Methods The clinical data of 61 cases underwent RLU were retrospectively analyzed,the diameters of the calculi varied from 6 to 26 mm,the average was 12.7mm,the courses of the disease of 58 patients were more than 2 months.All the cuts of ureters were well sutured and D -J tube of 5 -7F were well placed.Results Of all the cases,59 patients underwent RLU successfully,only 2 ease converted to operation.;the time consuming of the operations ranged from 40 to 135 minutes,the average was 53 minutes;the average of the amount of blood loss were 18 ml;the time of retaining of the draining tube after operation ranged from 1 to 4 days,D -J tubes were removed 2 to 4 weeks after operation.without complications such as leakage of urine,etc.The postoperative hospital stay was 4 to 9 days,During the follow - up period of 52 cases,there was no ureteric stricture or recurrent calculus had been found,and all patients'renal function had been improved.Conclusions Our experience indicates that operative techniques such as placing a duble J tube quickly shorten the operation time of RLU.As a kind of micro - insult operation for upperureteric calculi,RLU is very safe and effective,especially to the cases without history of retroperitoneal oprations,big calculi,severe hydronephrosis,or the cases which failed in other ways.