经脐单孔腹腔镜输尿管及肾盂切开取石术18例临床分析

发布时间：2018-04-15 00:36

本文选题：经脐单孔腹腔镜 + 输尿管切开取石术　；参考：《第三军医大学学报》2017年01期

【摘要】：目的探讨经脐单孔腹腔镜下输尿管及肾盂切开取石术的应用。方法 2014年5月至2015年5月,行经脐单孔腹腔镜输尿管及肾盂切开取石术18例21侧,包括男性5例,女性13例,平均年龄35.5岁,均为单发结石,平均最大径为2.5 cm,结石分别位于输尿管上段13枚,中段3枚,下段2枚,肾盂3枚;感染或积脓5例。患侧高70°斜卧位,取脐周"U"形切口约3 cm,置入"1环3通道"装置,30°腹腔镜及普通腹腔镜器械,用改良法置入D-J管后,间断缝合输尿管壁,改良法打结。结果手术均成功完成,单侧手术时间平均97 min,术中平均出血15 m L,术后平均3.5 d出院,术后1~2个月D-J管拔除后影像学复查,未见局部狭窄及结石残留,伤口愈合美观,温哥华疤痕评分平均为2.3分。结论对于较大的、感染性的、复杂的输尿管或肾盂结石,不宜采用输尿管镜或经皮肾镜等微创治疗手段或治疗失败的患者,可选择经脐单孔腹腔镜输尿管或肾盂切开取石术治疗。
[Abstract]:Objective to explore the application of single-hole laparoscopic ureterotomy and pyelolithotomy.Methods from May 2014 to May 2015, 18 patients (21 sides) underwent laparoscopic ureterotomy and pyelolithotomy through umbilical cord, including 5 males and 13 females, with an average age of 35.5 years.The mean maximum diameter was 2.5 cm, with 13 stones in the upper ureter, 3 in the middle segment, 2 in the lower segment, 3 in the renal pelvis, and 5 in infection or pyosis.The injured side was 70 掳high in oblique recumbent position. The periumbilical "U" incision was taken about 3 cm, and the "1 loop and 3 channel" device was placed with 30 掳laparoscopy and common laparoscopic instruments. After D-J tube was placed in the modified method, the ureteral wall was sutured intermittently, and the improved method was used to tie the knot.Results all the operations were completed successfully, the mean time of unilateral operation was 97 min, the average bleeding was 15 mL during operation, and the average was 3.5 days after operation. After 1 ~ 2 months after removal of D-J tube, there was no local stenosis and residual stone, and the wound healed beautifully.Vancouver scar score was 2.3 on average.Conclusion for the large, infectious and complicated ureteral or pelvis calculi, it is not advisable to use ureteroscopy or percutaneous nephroscopy as a minimally invasive treatment or failure in treatment.Laparoscopic ureterotomy or pyelolithotomy can be used to treat the patients.
【作者单位】：云南省第一人民医院泌尿外科;
【分类号】：R699

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