Kramer Brandan A, Hammond Lara, Schwartz Bradley F
Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9665, USA.
J Endourol. 2007 Aug;21(8):860-1. doi: 10.1089/end.2006.0410.
Laparoscopic pyelolithotomy, although uncommonly performed, may be considered in patients who have renal anomalies, are poorly compliant, and have a large single renal-pelvic calculus. We present our experience with this procedure in five patients.
Three patients underwent laparoscopic pyelolithotomy because of a horseshoe kidney, one for a pelvic kidney, and one for a large renal-pelvic calculus. All stones were solitary with a mean size of 2280 mm2 (range 540-8200 mm2). All were approached transperitoneally with passage of a flexible cystoscope through a laparoscopic port to aid in stone extraction.
All cases were completed laparoscopically. The length of surgery was 74, 92, 134, 158, and 159 minutes. There were no minor or major complications, and the estimated blood loss was <50 mL in all cases. All patients were discharged on postoperative day 1 with the drains removed. Four patients were stented for 4 to 6 weeks. The remaining patient was not stented because of poor compliance. The stents were removed with office cystoscopy. All patients were stone free on follow-up imaging.
Laparoscopic pyelolithotomy can be done safely, effectively, and efficiently with proper patient selection and adherence to standard laparoscopic surgical principles.
腹腔镜肾盂切开取石术虽不常施行，但对于有肾脏异常、依从性差且有单个大肾盂结石的患者可予以考虑。我们介绍5例该手术的经验。
3例马蹄肾患者、1例盆腔肾患者及1例有大肾盂结石的患者接受了腹腔镜肾盂切开取石术。所有结石均为单发，平均面积为2280平方毫米（范围540 - 8200平方毫米）。均经腹腔途径，通过腹腔镜端口插入软性膀胱镜以协助取石。
所有病例均在腹腔镜下完成。手术时间分别为74、92、134、158及159分钟。无轻微或严重并发症，所有病例估计失血量均<50毫升。所有患者术后第1天拔除引流管后出院。4例患者留置支架4至6周。其余1例患者因依从性差未留置支架。支架在门诊膀胱镜检查时取出。随访影像学检查显示所有患者结石清除。
通过适当选择患者并遵循标准腹腔镜手术原则，腹腔镜肾盂切开取石术可安全、有效且高效地完成。
