Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
J Endourol. 2009 Nov;23(11):1867-70. doi: 10.1089/end.2008.0536.
To summarize our experience and evaluate the learning curve of retroperitoneal laparoscopic ureterolithotomy of the upper ureter.
Between May 2004 and May 2007, 40 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. We divided the first and last 20 patients into group I and group II. There was no statistical difference in stone size between groups. Operative time and complications were measured as a basis for the assessment of the learning curve.
In group I, the complication rate was 15% (3/20), including two patients whose procedure was converted to open surgery because of intraoperative bleeding, and one patient who experienced urine leakage because of a displaced Double-J ureteral stent. In group II, no postoperative complications occurred, while the mean operative time was significantly shorter compared with the earlier operations (65 vs 120 min).
Retroperitoneal laparoscopic ureterolithotomy is safe and effective for large or impacted stones of the upper ureter. It is associated with a short learning curve in the setting of an active laparoscopic practice for selected patients.
总结我们的经验并评估后腹腔镜输尿管上段切开取石术的学习曲线。
2004 年 5 月至 2007 年 5 月，40 例患者接受了后腹腔镜输尿管上段切开取石术。我们将前 20 例和最后 20 例患者分为 I 组和 II 组。两组结石大小无统计学差异。手术时间和并发症作为评估学习曲线的依据。
I 组并发症发生率为 15%（3/20），包括 2 例因术中出血改行开放手术的患者和 1 例因双 J 输尿管支架移位导致尿漏的患者。II 组无术后并发症，而手术时间明显短于早期手术（65 分钟比 120 分钟）。
对于较大或嵌顿性上段输尿管结石，后腹腔镜输尿管上段切开取石术是安全有效的。对于选择的患者，在积极开展腹腔镜手术的情况下，其学习曲线较短。
