Exploration for the technique of single lateral free ureterolithotomy by retroperitoneoscope
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摘要: 目的：探讨后腹腔镜单侧面游离输尿管切开取石术的临床疗效及应用价值。方法：回顾性分析我院2018年5月—2019年12月65例经后腹腔镜输尿管切开取石术治疗的患者临床资料；将患者分为两组，A组41例接受单侧面纵向游离输尿管切开取石治疗，B组24例接受完全游离输尿管切开取石治疗。对两组患者手术时间、术中出血量、术后疼痛反应、伤口引流管留置时间、取石率、住院时间及术后短期并发症情况进行对比分析。结果：两组手术均获得成功，其中A组2例术中结石上移至肾内，改开放手术取石成功；随访6个月两组患者均未出现漏尿、输尿管穿孔等并发症；两组患者在术后疼痛评分[（3.8±1.57）分vs.（4.2±1.25）分，t=1.08，P>0.05]、取石率[95% vs.100%，χ2=0.13，P>0.05]方面差异无统计学意义；与B组比较，A组平均手术时间短[（62.6±12.45） min vs.（73.1±10.62） min，t=3.46，p<0.05]、术中出血量少[（38.9±21.29） mLvs.（54.0±21.47） mL，t=2.74，P<0.05]、伤口引流管留置时间短[（74.9±18.43） h vs.（91.2±19.25） h，t=3.39，P<0.05]、住院时间[（7.3±1.96） d vs.（8.9±1.86） d，t=3.19，P<0.05]。结论：后腹腔镜单侧面纵向游离输尿管切开取石治疗输尿管上段结石效果确切，具有损伤小、手术时间短、康复快等优点，是一种值得临床应用和继续探讨的手术技巧。Abstract: Objective: To explore the clinical effect and application value of retroperitoneal laparoscopic single lateral free ureterolithotomy.Methods: From May 2018 to December 2019, the clinical data of 65 patients who underwent retroperitoneal laparoscopic ureterolithotomy were analyzed retrospectively. Forty-one patients in group A received unilateral longitudinal free ureterolithotomy, while 24 patients in group B received complete free ureterolithotomy. The operation time, intraoperative bleeding volume, postoperative pain response, drainage tube retention time, stone removal rate, hospital stay time and postoperative short-term complications of the two groups were compared and analyzed.Results: The operation was successfully performed in all patients, and after six months follow-up, there were no complications with Ieakage of urine or ureteral perforation in both groups. Two cases of stones were moved up to the kidney and successfully removed by the open operation in A group. There was no significant difference between the two groups in postoperative pain score[(3.8±1.57) scores vs.(4.2±1.25) scores, t=1.08, P>0.05], stone removal rate(95% vs. 100%,χ2=0.13, P>0.05). There was significant difference in average operation time[(62.6±12.45) min vs.(73.1±10.62) min, t=3.46, P<0.05], intraoperative hemorrhage[(38.9±21.29) mL vs.(54.0±21.47) mL, t=2.74, P<0.05], retention time of drainage tube[(74.9±18.43) h vs.(91.2±19.25) h, t=3.39, P<0.05], the hospital stay time[(7.3±1.96) d vs.(8.9±1.86) d, t=3.19, P<0.05] between the two groups.Conclusion: Retroperitoneal laparoscopic single lateral longitudinal free ureterolithotomy is an effective method for the treatment of upper ureteral calculi. It has the advantages of little injury, short operation time and quick recovery. It is worthy of clinical application and further discussion.
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