Hruza Marcel, Schulze Michael, Teber Dogu, Gözen Ali Serdar, Rassweiler Jens Jochen
Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University , Heilbronn, Germany .
J Endourol. 2009 Oct;23(10):1713-8. doi: 10.1089/end.2009.1539.
Although most ureteral and renal stones are managed using endourologic techniques or shockwave lithotripsy in daily clinical practice, stone surgery has not completely disappeared. The increasing experience with laparoscopy in urology poses the question of whether urolithiasis may be an indication for laparoscopy.
A review of the literature was conducted to point out the indications and techniques of laparoscopic stone surgery.
Indications for stone surgery are anatomic abnormalities, such as horseshoe kidneys, malrotated kidneys, or ectopic kidneys; symptomatic stones in diverticula of the renal pelvis; and extremely large stones, especially in children; or concomitant open or laparoscopic surgery. After failure of endourologic stone removal or shockwave lithotripsy, stone surgery may be a second option. In experienced hands, most procedures can be performed laparoscopically, either using a retroperitoneal or a transperitoneal approach. Accurate planning and imaging before surgery is mandatory. Intracorporeal ultrasonography or combined laparoscopic and endourologic techniques may be useful in difficult cases. Functional outcomes and complication rates of the laparoscopic approach are comparable to those of open surgery. The benefits of laparoscopy are lower postoperative morbidity, shorter hospitalization, shorter convalescence time, and better cosmetic results.
Laparoscopic removal of renal and ureteral calculi plays a role in special cases of urolithiasis. In experienced hands, it can be performed safely and efficiently and may therefore replace open stone surgery in most indications.
尽管在日常临床实践中，大多数输尿管结石和肾结石是采用腔内泌尿外科技术或冲击波碎石术进行治疗，但开放性结石手术并未完全消失。泌尿外科腹腔镜技术经验的不断积累引发了一个问题，即尿路结石是否可能成为腹腔镜手术的适应证。
对文献进行综述，以指出腹腔镜结石手术的适应证和技术。
结石手术的适应证包括解剖学异常，如马蹄肾、旋转不良肾或异位肾；肾盂憩室内有症状的结石；以及极大的结石，尤其是儿童患者；或合并开放性或腹腔镜手术。在腔内泌尿外科结石取出术或冲击波碎石术失败后，结石手术可能是第二种选择。在经验丰富的医生手中，大多数手术可以通过腹腔镜进行，可采用腹膜后或经腹途径。术前进行精确的规划和影像学检查是必不可少的。体内超声检查或腹腔镜与腔内泌尿外科技术联合应用在困难病例中可能有用。腹腔镜手术的功能结果和并发症发生率与开放性手术相当。腹腔镜手术的优点是术后发病率较低、住院时间较短、康复时间较短以及美容效果更好。
腹腔镜下切除肾和输尿管结石在尿路结石的特殊病例中发挥着作用。在经验丰富的医生手中，它可以安全、有效地进行，因此在大多数适应证中可能取代开放性结石手术。
