CAJ | 학술논문

目的总结经腹腹腔镜治疗输尿管上段结石经验,探讨其在输尿管嵌顿结石治疗中的价值.方法 1999年9月至2012年2月共收治1171例输尿管上段结石患者.其中嵌顿性结石1100例,非嵌顿性结石71例；单侧输尿管多发结石51例；合并同侧肾脏小结石139例.结石最大径0.8 ～2.6 cm,平均1.5 cm.均采用经腹腔途径完成腹腔镜输尿管切开取石术,术中留置输尿管支架管及手术部位引流管.结果 1171例患者中2例改开放手术；27例结石上移进入肾盂,其中25例改行腹腔镜肾盂切开取石术成功取出结石,2例未能找到结石,留置输尿管支架管后体外碎石治疗,该27例患者均为非嵌顿性结石或输尿管多发结石.其余1142例手术均顺利完成,手术时间26～160 min,平均56.1 min;术中出血量10～250 ml,平均45.2 ml；术后引流管拔除时间1～7d,平均3.1d;术后住院时间3～9d,平均4.8d.术后出现漏尿1例,6d后好转；支架管未到位或回缩10例,均于术后经输尿管镜拔除；麻痹性肠梗阻1例,术后1周后好转；术后严重血尿1例,经保守治疗后治愈；未见肠道及邻近脏器损伤、腹腔感染等并发症.827例术后获随访2个月～9年,平均7.3个月,术后输尿管狭窄12例,其中2例为术中发现合并输尿管息肉患者,7例接受输尿管扩张或球囊扩张治疗,3例行输尿管端端吻合,2例失随访；另有5例术前重度肾积水患者术后出现肾脏萎缩,2例无明显症状定期随访,3例因反复腰痛或反复泌尿系统感染接受患肾切除手术.结论经腹腔入路腹腔镜输尿管切开取石术安全可行,结石取净率高,创伤小、恢复快,在输尿管上段嵌顿性结石治疗中可取代开放手术.
목적 총결경복복강경치료수뇨관상단결석경험,탐토기재수뇨관감돈결석치료중적개치.방법 1999년9월지2012년2월공수치1171례수뇨관상단결석환자.기중감돈성결석1100례,비감돈성결석71례；단측수뇨관다발결석51례；합병동측신장소결석139례.결석최대경0.8 ～2.6 cm,평균1.5 cm.균채용경복강도경완성복강경수뇨관절개취석술,술중류치수뇨관지가관급수술부위인류관.결과 1171례환자중2례개개방수술；27례결석상이진입신우,기중25례개행복강경신우절개취석술성공취출결석,2례미능조도결석,류치수뇨관지가관후체외쇄석치료,해27례환자균위비감돈성결석혹수뇨관다발결석.기여1142례수술균순리완성,수술시간26～160 min,평균56.1 min;술중출혈량10～250 ml,평균45.2 ml；술후인류관발제시간1～7d,평균3.1d;술후주원시간3～9d,평균4.8d.술후출현루뇨1례,6d후호전；지가관미도위혹회축10례,균우술후경수뇨관경발제；마비성장경조1례,술후1주후호전；술후엄중혈뇨1례,경보수치료후치유；미견장도급린근장기손상、복강감염등병발증.827례술후획수방2개월～9년,평균7.3개월,술후수뇨관협착12례,기중2례위술중발현합병수뇨관식육환자,7례접수수뇨관확장혹구낭확장치료,3례행수뇨관단단문합,2례실수방；령유5례술전중도신적수환자술후출현신장위축,2례무명현증상정기수방,3례인반복요통혹반복비뇨계통감염접수환신절제수술.결론 경복강입로복강경수뇨관절개취석술안전가행,결석취정솔고,창상소、회복쾌,재수뇨관상단감돈성결석치료중가취대개방수술.
Objective To evaluate clinical outcomes and values of transperitoneal laparoscopic ureterolithtomy.Methods A total of 1171 patients with upper ureteral calculi were recruited during September 1999 to February 2012.The etiologies included impacted calculi (n =1100),non-impacted calculi (n =71),multiple ureteral calculi (n =51) and combined small calculi in unilateral kidney (n =139).Maximum diameter of calculi was 1.5 (0.8-2.6) cm.All patients underwent transperitoneal laparoscopic ureterolithtomy and double J stent was implanted intraoperatively.Results Two cases were converted into open operation.Calculi moving up into pelvis occurred in 27 cases.And 25 cases converted into laparoscopic pyelolithotomy and stones were removed successfully.Two cases received extra extracorporeal shock wave lithotripsy postoperatively.The remaining 1142 cases were treated successfully with an operative duration of 56.1 (26-160) min and an estimated volume of blood loss at 45.2 (10-250) ml.The period of drainage tube was 3.1 (1-7) days.Postoperative hospitalization stay was 4.8 (3-9) days.One patient suffered urine leakage and healed at Day 6 days post-operation.Ten cases suffered D-J stent bladder non-arrival or retraction and double J stents were extracted by ureteroscopy.One case suffered paralytic ileus and recovered 7 days later.Another case suffered severe hematuria.No intestine or adjacent viscera injury was observed.The follow-up period of 827 cases was 7.3 (24-108) months.Among 12 cases of ureteral stricture,ureteral dilation (n =7) and ureteral anastosmosis (n =3) were performed.For 5 cases of renal atrophy,3 underwent nephrectomy because of recurrent lumbago or persistent urinary infection.Conclusions Transperitoneal laparoscopic ureterolithotomy has the advantages of minimal morbidity,little postoperative discomfort and high stone clearance rate over open surgery.It should be widely adopted for the patients with upper ureteral impacted calculi.