腹腔镜下输尿管切开取石术的适应证再探讨：附63例报告

卢俊霖; 余虓; 李聪; 张加桥; 崔磊; 寻阳; 王少刚

doi:10.13201/j.issn.1001-1420.2021.05.010

腹腔镜下输尿管切开取石术的适应证再探讨：附63例报告

- 华中科技大学同济医学院附属同济医院泌尿外科(武汉, 430030)

详细信息

通讯作者: 王少刚,E-mail:sgwangtjm@163.com

中图分类号: R693

收稿日期: 2020-05-05

Clinical indications for laparoscopic ureterolithotomy treating proximal ureteral stone in 63 cases

- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

More Information

Corresponding author: WANG Shaogang, E-mail: sgwangtjm@163.com

Received Date: 05 May 2020

摘要

摘要: 目的:总结采用腹腔镜下输尿管切开取石术(LU)治疗输尿管上段结石的临床经验,并探讨其手术适应证。方法:回顾性分析2012年1月—2018年12月我院63例行LU的输尿管上段结石患者的临床资料,患者平均年龄(51.57±12.37)岁,其中男性占73%。结石长径中位数为13 mm,术前1个月有尿路感染的患者占22.2%,其中1例术前发生感染性休克。纳入的术式中52例腹膜后入路LU,8例经腹腔入路LU,3例机器人辅助经腹腔入路LU。收集患者术前资料(结石长径、术前尿路感染、伴随疾病等)、术前/后血液指标变化(肌酐、血红蛋白)、手术时间、清石率、术后并发症。结果:患者术前肌酐中位数86(48~199)μmol/L,术后肌酐中位数86(49~189)μmol/L。术后血红蛋白下降中位数6(1~41) g/L。总清石率96.8%。共出现2例患者发生术后并发症,1例因腹痛再次入院(Clavien-DindoⅠ级),1例出现漏尿并血红蛋白下降(Clavien-DindoⅢ级),2例患者均为腹膜后入路组。结论:腹腔镜下LU治疗输尿管上段结石清石率高,并发症少。应用腹腔镜手术应全面评估其适应证,如肾盂输尿管解剖、术前尿路感染、肾功能不全等情况。
- 腹腔镜下输尿管切开取石术 /
- 手术适应证 /
- 尿路感染 /
- 输尿管结石
Abstract: Objective: To analyze the clinical experience of laparoscopic ureterolithotomy(LU) in the treatment of proximal ureteral stone, and to discuss its indications.Methods: Patients who underwent LU for proximal ureteral stone from January 2012 to December 2018 were retrospectively analyzed. A total of 63 patients were included in this study, with an average age of(51.57±12.37) years, of which 73% were male. The median length of stone was 13 mm, and 22.2% of the patients had urinary tract infection one month before surgery, including 1 case of septic shock. Fifty-two cases received retroperitoneal surgery; 8 cases received intraperitoneal surgery; 3 cases received robot-assisted intraperitoneal surgery. Preoperative data of the patients(age, sex, height, weight, length of stone, degree of hydronephrosis, preoperative urinary tract infection, previous abdominal surgery, concomitant disease), changes in serum indicators(creatinine, hemoglobin), operation time, stone free rate, and postoperative complications were collected.Results: The median creatinine was 86(48-199) μmol/L preoperatively and 86(49-189) μmol/L postoperatively. The median hemoglobin decrease was 6 g/L. The median operation time was 113 min. The total stone free rate was 96.8%. There were two cases developing complication. One case experienced abdominal pain(Clavien-DindoⅠlevel), and the other case suffered from urine leakage and hemoglobin decrease(Clavien-Dindo Ⅲ level). These two cases were both in retroperitoneal group.Conclusion: Laparoscopic ureterolithotomy for the treatment of proximal ureteral stone has a high stone-free rate and low complications. Indications for laparoscopic surgery, such as ureteropelvic anatomy, preoperative urinary tract infection and renal insufficiency should be fully evaluated.
- laparoscopic ureterolithotomy /
- surgical indication /
- urinary tract infection /
- ureteral stone

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参考文献(12)

[1]	Zeng G,Mai Z,Xia S,et al.Prevalence of kidney stones in China:an ultrasonography based cross-sectional study[J].BJU Int,2017,120(1):109-116.
[2]	那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:128-213.
[3]	Li J,Chang X,Wang Y,et al.Laparoscopic ureterolithotomy versus ureteroscopic laser lithotripsy for large proximal ureteral stones:a systematic review and meta-analysis[J].Minerva Urol Nefrol,2020,72(1):30-37.
[4]	Wang K,Wang G,Shi H,et al.Analysis of the clinical effect and long-term follow-up results of retroperitoneal laparoscopic ureterolithotomy in the treatment of complicated upper ureteral calculi(report of 206 cases followed for 10 years)[J].Int Urol Nephrol,2019,51(11):1955-1960.
[5]	Somani BK,Giusti G,Sun Y,et al.Complications associated with ureterorenoscopy(URS)related to treatment of urolithiasis:the Clinical Research Office of Endourological Society URS Global study[J].World J Urol,2017,35(4):675-681.
[6]	罗道升,林伟卓,莫俊华,等.3种腹腔镜输尿管切开取石术治疗L4平面以下输尿管嵌顿性巨大结石的疗效比较[J].临床泌尿外科杂志,2019,34(3):189-192.
[7]	Yang H,Yu X,Peng E,et al.Urgent laparoscopic ureterolithotomy for proximal ureter stones accompanied with obstructive pyelonephritis:Is it safe and effective without preoperative drainage?[J].Medicine(Baltimore),2017,96(45):e8657.
[8]	Shao Y,Wang DW,Lu GL,et al.Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm[J].World J Urol,2015,33(11):1841-1845.
[9]	黄亚强,黄红星,麦智鹏,等.后腹腔镜输尿管切开取石术治疗输尿管上段结石并肾功能不全[J/OL].中华临床医师杂志(电子版),2017,11(10):1651-1654.
[10]	Swearingen R,Sood A,Madi R et al.Zero-fragment Nephrolithotomy:A Multi-center Evaluation of Robotic Pyelolithotomy and Nephrolithotomy for Treating Renal Stones[J].Eur Urol,2017,72(6):1014-1021.
[11]	Reeves T,Pietropaolo A,Somani BK.Ureteroscopy and Laser Stone Fragmentation Is Safe and Tends to Improve Renal Function in Patients with Chronic Kidney Disease:Prospective Outcomes with a Minimum Follow-Up of 6 Months[J].J Endourol,2020,34(4):423-428.
[12]	Sairam K,Scoffone CM,Alken P,et al.Percutaneous Nephrolithotomy and Chronic Kidney Disease:Results from the CROES PCNL Global Study[J].J Urol,2012,188(4):1195-1200.