摘要
目的:探讨腹腔镜肾盂成形联合电子膀胱软镜或输尿管软镜治疗肾盂输尿管连接部梗阻(UPJO)合并肾结石。方法:回顾性分析2019年1月至2021年1月收治的15例UPJO合并肾结石患者的临床资料,采用腹腔镜联合软镜技术,可一期利用微创技术同时从根本上处理两种疾病,达到临床治愈;术中先利用腹腔镜游离出扩张的肾盂和输尿管上段,在扩张的肾盂拟裁剪处先切开1cm,置入电子膀胱软镜或电子输尿管软镜,直视下用三边或四边套石网篮取出结石,较大结石取出困难时置入钬激光碎石,结石清除后采用Anderson-Hynes法行腹腔镜肾盂成形术。结果:本组15例患者均一期完成手术,结石均完全清除,1例术中置入戳卡导致肝损伤中转开放手术。手术时间140~230(140.03±36.58)min,术后下地时间24~72(39±17)h,住院时间(7.0±2.2)d。术后8周拔除双J管(D-J管),随访7~21个月,15例肾脏积水均明显改善,腰疼缓解,术后无严重并发症发生。结论:腹腔镜肾盂成形术联合电子膀胱软镜或电子输尿管软镜同期治疗UPJO合并肾结石安全、可靠,具备创伤小、恢复快,清石率高,值得临床应用。
Objective:To investigate laparoscopic pyeloplasty combined with electron cystoscope or ureteroscope for the treatment of ureteropelvic junction obstruction(UPJO)complicated with renal calculi.Methods:Retrospective review of the clinical data of 15 patients with renal stones treated with UPJO between January 2019 and January 2021.With the use of laparoscopy combined with soft endoscope,we can simultaneously fundamentally treat two diseases with the use of minimally invasive technique in the first stage and achieve clinical cure.The dilated renal pelvis and upper ureter was educed intraoperatively with laparoscope.The clipping of dilated renal pelvis was cut 1 cm,electron cystoscope or electron ureteralscope was implanted,stone was removed with a three-or four-sided stone basket under direct visual inspection,and larger stone was removed through holium laser lithotripsy,laparoscopic pyeloplasty was performed using the Anderson-Hynes method.Results:All patients finished the first stage of surgery in this group.Stones were completely removed.One patient was transfered to open surgery due to hepatic injury caused by intraoperative postponing card.The surgical duration was 140~230(140.03±36.58)min,the postoperative departure time was 24~72(39±17)h,and the hospital stay was(7.0±2.2)d.D-J ureteral stents were removed 8weeks postoperatively and followed up for 7~21 months.Hydronephrosis were improved significantly in all 15 patients,and low back pain was relieved.No serious postoperative complications occurred.Conclusion:Laparoscopic pyeloplasty combined with electron cystoscopy or electron ureteroscopy for simultaneous treatment of UPJO with renal stone is safe and reliable,with minimal trauma,rapid recovery and high rate of stone clearance,and is worthy of clinical application.
作者
丁彦才
刘丽
李飞宇
杨涛
马小云
席海峰
邵永祥
王乔峰
Ding Yancai;Liu Li;Li Feiyu;Yang Tao;Ma Xiaoyun;Xi Haifeng;Shao Yongxiang;Wang Qiaofeng(Department of Urology,942 Hospital of PLA,Yinchuan 750021,China)
出处
《微创泌尿外科杂志》
2022年第5期317-320,共4页
Journal of Minimally Invasive Urology
关键词
肾盂
输尿管梗阻
腹腔镜
肾结石
renal pelvis
ureteral obstruction
laparoscopy
renal calculi
