摘要:目的:探討后腹腔鏡輸尿管切開取石術(shù)治療嵌頓性輸尿管結(jié)石的臨床價(jià)值和技術(shù)要點(diǎn)。 方法:2006年12月至 2009年3月,對(duì)58例嵌頓性輸尿管中上段結(jié)石采用后腹腔鏡輸尿管切開取石術(shù),術(shù)中取石后于鏡下直接置入雙J管,間段縫合輸尿管切口。 結(jié)果:58例手術(shù)均獲成功,無中轉(zhuǎn)開放手術(shù),結(jié)石清除率100%。術(shù)后創(chuàng)腔引流液量少,3～5d拔除引流管,1周出院,術(shù)后3周膀胱鏡下拔除雙J管。隨訪1～27個(gè)月,B超復(fù)查顯示腎積水明顯好轉(zhuǎn)或消失,無結(jié)石復(fù)發(fā)。 結(jié)論:后腹腔鏡輸尿管切開取石術(shù)治療嵌頓性輸尿管結(jié)石具有創(chuàng)傷小\療效好、術(shù)后恢復(fù)快等特點(diǎn),明顯優(yōu)于開放手術(shù)及其它手術(shù),值得推廣應(yīng)用。Abstract: Objective: To summarize our experience and evaluate the outcome of retroperitoneal laparoscopic ureterolithotomy of the upper ureter impacted stone. Methods: Between December 2006 and March 2009, 58 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. After removal of the stones, the double J was put in and interrupted suture was performed for upper ureter. Results: Retroperitoneoscopic ureterolithotomy was successful in all patients, there was neither ureteral stricture nor recurrent calculus, the blood loss ranged from 510 mL, without urine leakage occurred.The mean hospital stay was 7 days, after 3 weeks double J was removed by cystoscopy. With 127 months followup, the hydronephrosis relieved and no recurrence of ureter calculus founded. Conclusion:Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive operation, and worth to generalization.
目的系統(tǒng)評(píng)價(jià)經(jīng)尿道輸尿管鏡碎石術(shù)治療輸尿管上段結(jié)石的安全性和有效性。 方法計(jì)算機(jī)檢索The Cochrane Library（2013年第3期）、PubMed（1966～2013.8）、EMbase（1990～2013.8）、CNKI（1949～2013.9）、CBM（1978～2013.9）、VIP（1989～2013.8）和WanFang Data（1990～2013.8），全面收集有關(guān)后腹腔鏡輸尿管切開取石術(shù)和經(jīng)尿道輸尿管鏡碎石術(shù)比較治療輸尿管上段結(jié)石的隨機(jī)對(duì)照試驗(yàn)（RCT）。由2位研究者獨(dú)立進(jìn)行文獻(xiàn)篩選、資料提取和評(píng)價(jià)納入研究的方法學(xué)質(zhì)量后，采用RevMan5.2軟件進(jìn)行Meta分析。 結(jié)果共納入16個(gè)RCT，1 410例患者，其中輸尿管鏡組747例，后腹腔鏡組663例。Meta分析結(jié)果顯示：輸尿管鏡組在手術(shù)成功率［OR=0.26，95% CI（0.14，0.51）］、3天結(jié)石清除率［OR=0.06，95% CI（0.03，0.11）］和1月結(jié)石清除率［OR=0.21，95% CI（0.08，0.53）］方面均低于后腹腔鏡組，但在手術(shù)時(shí)間［MD=–22.35，95% CI（–35.29，–9.41）］、術(shù)后住院時(shí)間［MD=–1.84，95% CI（–3.44，–0.24）］方面優(yōu)于后腹腔鏡組。 結(jié)論現(xiàn)有證據(jù)表明：對(duì)于輸尿管上段結(jié)石，經(jīng)尿道輸尿管鏡碎石術(shù)比后腹腔鏡輸尿管切開取石術(shù)手術(shù)時(shí)間及術(shù)后住院時(shí)間更短，但在手術(shù)成功率、清石率及并發(fā)癥發(fā)生率等方面并無優(yōu)勢(shì)。