摘要
目的探讨后腹腔镜输尿管切开取石术在治疗输尿管上段结石合并肾功能不全患者的有效性及安全性。方法回顾性分析中山市人民医院2011年3月至2015年2月行后腹腔镜输尿管切开取石术的62例输尿管上段结石合并肾功能不全患者的临床资料,评价该方法的临床价值。结果 62例患者均顺利完成手术,其中男性39例,女性23例,左侧35例,右侧27例,孤立肾4例,术前发热10例,既往有明确慢性肾脏病史13例,接受过体外冲击波碎石9例。平均年龄38(16~72)岁,结石大小1.3(0.8~2.3)cm,手术时间(62.5±28.1)min,术后下床活动时间(1.3±0.6)d。术后平均住院时间(4.0±1.8)d,输尿管净石率100%。总并发症发生率为14.51%(9例),其中ClavienⅠ、Ⅱ、Ⅲa并发症分别为9.67%(6例)、3.22%(2例)、1.61%(1例)。术后出现尿漏1例,经调整双J管后痊愈。无术中输血、术后感染性休克病例。术前、术后1个月平均血肌酐分别为(196±68)μmol/L和(115±36)μmol/L(P=0.003)。平均随访(15.2±6.1)个月,输尿管结石复发3例,经输尿管镜钬激光碎石治疗痊愈。结论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有效,能较快解除输尿管梗阻,改善肾功能,并具有微创、净石率高、出血风险小等优点,值得临床推广应用。
Objective To evaluate the efficacy and safety of retroperitoneal laparoscopic ureterolithotomy in the treatment of upper ureteral calculi cocurrent with renal insufficiency. Methods The clinical data of 62 patients with upper ureteral calculi complicated with renal insufficiency who underwent laparoscopic ureterolithotomy from March 2011 to February 2015 were analyzed retrospectively. Details on operative time, stone clearance rate, hospital stay, complications, renal function and stone recurrence were reviewed. Results In all, 62 patients were successfully completed the operation, including 39 males and 23 females. 35 stones located on the left side and 27 on the right side, respectively. There were 4 patients with solitary kidney and 10 patients had fever, 13 cases had suffered CKD and 9 cases received extracorporeal shock wave lithotripsy before surgeries. The mean age, mean operative time, mean stone size, mean postoperative hospitalization and Stone clearance rate were 38(16-72) years,(62.5±28.1) minutes, 1.3(0.8-2.3) cm,(4.0±1.8) days and 100%, respectively. The overall complications was 14.51%(9/62), and the mean serum creatinine was(196±68) μmol/L before and(115±36) μmol/L one month after surgery(P=0.003). One patient experienced urine fistula(1.61%) and double J stent replacement was needed. The average follow-up was(15.2±6.1) months, three patients underwent stone recurrence and ureteroscopic holmium laser lithotripsy was required. Conclusion Retroperitoneal laparoscopic ureterolithotomy is effective for the treatment of upper ureteral calculi concurrent with renal insufficiency. It can relieve ureteral obstruction quickly and improve renal function. It has the advantages of minimally invasive, high stone clearance rate and low risk of hemorrhage.
出处
《中华临床医师杂志（电子版）》
CAS
2017年第10期1651-1654,共4页
Chinese Journal of Clinicians(Electronic Edition)
基金
中国博士后科学基金(2016M590842)
中山市科技计划项目基金(2016B1028)
关键词
输尿管上段结石
腹腔镜
肾功能不全
Upper ureteral calculi
Laparoscopic
Renal insufficiency
