Nualyong C, Taweemonkongsap T
Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 1999 Oct;82(10):1028-33.
Laparoscopic ureterolithotomy was performed on 10 patients with upper ureteric stones indicated for open ureterolithotomy after failed prior minimally invasive approaches. Stone size ranged from 7 to 15 mm. (mean 9.3). The routes of approach were all done transperitoneally except in one case in which the retroperitoneal route was initially attempted and later converted to transperitoneal route due to contracted space and unclear landmarks. Stones were all removed successfully with the operating time ranging from 120 to 270 min. (mean 181.5). The only significant complication encountered was urine leak interval postoperatively which were long in 4 patients in whom ureterotomy was not sutured. The longest urine leak interval was seen in a patient whose ureterotomy was neither sutured nor stented. Postoperative pain was rewarding in that seven patients required a single dose of 50 mg of pethidine, two required only oral paracetamol and one required no analgesic at all. Postoperative hospital stay ranged from 5 to 23 days which was actually overwhelmed by urine leak complication. Recovery period was satisfactory which ranged from 10 to 28 days (mean 18.1). Overall laparoscopic ureterolithotomy offers an alternative procedure to open ureterolithotomy with the advantages of minimal postoperative pain and short recovery period.
对10例上输尿管结石患者进行了腹腔镜输尿管切开取石术，这些患者在先前的微创治疗方法失败后，适合进行开放性输尿管切开取石术。结石大小为7至15毫米（平均9.3毫米）。除1例最初尝试经后腹膜途径，后因空间狭窄和解剖标志不清而转为经腹膜途径外，其余均采用经腹膜途径。所有结石均成功取出，手术时间为120至270分钟（平均181.5分钟）。唯一遇到的严重并发症是术后尿漏，4例输尿管切开未缝合的患者尿漏时间较长。尿漏时间最长的患者输尿管切开既未缝合也未放置支架。术后疼痛方面，7例患者需要单次注射50毫克哌替啶，2例仅需口服对乙酰氨基酚，1例根本不需要镇痛。术后住院时间为5至23天，实际上因尿漏并发症而延长。恢复期令人满意，为10至28天（平均18.1天）。总体而言，腹腔镜输尿管切开取石术为开放性输尿管切开取石术提供了一种替代方法，具有术后疼痛轻和恢复期短的优点。
