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目的:探讨后腹腔镜技术处理输尿管中上段结石的手术要点与临床应用价值。方法:2009年8月~2013年3月,共施行后腹腔镜输尿管中上段切开取石术36例,其中28例分别于术前行体外冲击波碎石(ESWL)、输尿管镜取石(URL)及微通道经皮肾镜取石术(mPCNL)失败。结石平均长径1.8(1.2~2.8)cm。结果:36例手术均获成功。手术时间65~150min,中位数85min。术中估计失血量15~65ml,中位数25ml。术后平均随访10(2~24)个月,无结石复发及输尿管狭窄发生。结论:后腹腔镜输尿管切开取石术可作为ESWL、URL、mPCNL失败后的有效补救治疗措施,是一种安全、有效的微创手术方法。
Objective: To investigate the operative points and clinical application value of retroperitoneal laparoscopy in the treatment of upper ureteral calculi. Methods: From August 2009 to March 2013, 36 patients underwent laparoscopic ureterolithotomy in upper and middle ureteral calculi, 28 of them were treated with extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URL) and Micro channel percutaneous nephrolithotomy (mPCNL) failed. The average diameter of stones 1.8 (1.2 ~ 2.8) cm. Results: Thirty-six surgeries were successful. Surgery time 65 ~ 150min, median 85min. Intraoperative blood loss was estimated 15 ~ 65ml, the median 25ml. After an average follow-up of 10 (2 ~ 24) months, no recurrence of stones and ureteral stricture. Conclusions: Retroperitoneoscopic laparoscopic ureterolithotomy can be used as an effective remedy for ESWL, URL and mPCNL failure. It is a safe and effective minimally invasive surgical procedure.