腹腔镜下两种手术路径行输尿管切开取石临床疗效比较.doc

腹腔镜下两种手术路径行输尿管切开取石临床疗效比较[摘要] 目的 分析比较腹腔镜下经腹与经腹膜后行输尿管切开取石术的疗效。方法 对我院2008年2月～2010年9月65例采用腹腔镜手术的输尿管结石患者随机分为经腹腔（31例）和经腹膜后（34例）两组，比较分析两种手术方式的治疗效果。 结果 65例患者均成功取石；两组在手术时间、术中出血量、术后留置引流管时间、住院时间、术后7 d结石清除率、术后3个月结石清除率方面差异均无统计学意义（P 0.05），但经腹膜后组疗效相对更好；并发症方面仅经腹组出现1例皮下气肿、经腹膜后组出现2例皮下气肿，未经处理自行吸收，两组均未出现尿漏。 结论 经腹与经腹膜后腹腔镜下输尿管切开取石术创伤小、并发症少、安全有效，均有很高的结石清除率，腹腔镜手术可作为输尿管结石的首选术式。 [关键词] 腹腔镜；输尿管结石；腹膜后 [中图分类号] R758.22 [文献标识码] B [文章编号] 1673—9701（2012）26—0155—02 Clinical effect of laparoscopic ureterolithotomy through two different surgery paths MI Dengbin Department of Urology，the Peoples Hospital of Wushan County in Chongqing，Wushan 404700，China [Abstract] Objective To compare the clinical effect of laparoscopic ureterolithotomy through two different surgery paths. Methods In the clinical study， from February 2008 to September 2010，65 patients treated by laparoscopic ureterolithotomy were divided randomly into abdominal cavity group（31 cases）and retroperitoneal group（34 cases），the clinical effect of two different surgery paths were compared. Results All patients completed the surgery successfully；the outcome of operation time、blood loss、drainage time、hospital stay，stone free rate of 7 d and 3 months after surgery of two groups had no significant difference（P all 0.05），but the clinical effect of the retroperitoneal group was comparatively superior to that of abdominal cavity group；the abdominal cavity group had 1 subcutaneous emphysema while the other group had 2 cases，but they were absorbed without treatment，and all patients had no urinary leak. Conclusion Laparoscopic ureterolithotomy through abdominal cavity path and retroperitoneal path are safe，high—performance，low—damage，the rate of adverse reaction is low and the stone free rate is high.Therefore，it is considered as the first choice of ureteral calculus treatment and worth popularizing. [Key words] Laparoscope；Ureteral calculus；Retroperitoneal 输尿管结石绝大多数来源于肾脏，包括肾结石或体外震波后结石碎块降落所致。在输尿管中、上段部位的结石嵌顿堵塞或结石下移过程中，常引起典型的患侧肾绞痛和镜下血尿，给