Nour Hani H, Elgobashy Samir E, Elkholy Amr, Kamal Ahmad M, Roshdy Mamdouh A, Elbaz Ahmad G, Riad Essam
Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
Arab J Urol. 2015 Sep;13(3):182-6. doi: 10.1016/j.aju.2015.06.006. Epub 2015 Jul 31.
To determine the efficacy and safety of the laparoscopic management of an impacted distal ureteric stone in a bilharzial ureter, as bilharzial ureters are complicated by distal stricture caused by the precipitation of bilharzial ova in the distal ureter. These cases are associated with poorly functioning and grossly hydronephrotic kidneys that hinder the endoscopic manipulation of the coexistent distal high burden of, and long-standing, impacted stones.
We used laparoscopic ureterolithotomy, with four trocars, to manage 51 bilharzial patients (33 men and 18 women; mean age 40.13 years) with distal ureteric stones. The ureter was opened directly over the stone and the stone was extracted. A JJ stent was inserted into the ureter, which was then closed with a 4-0 polyglactin running suture.
The mean stone size was 2.73 cm. Conversion to open surgery was required in only one patient. The mean operative duration was 92 min, the postoperative pain score was 20-60, the mean (range) number of analgesic requests after surgery was 1.72 (1-3), comprising once in 21 patients, twice in 23 and thrice in seven. The mean hospital stay was 2.74 days, and the total duration of follow-up was 7-12 months. The stone recurred in four patients and a ureteric stricture was reported in two. All patients were rendered stone-free.
Laparoscopy is a safe and effective minimally invasive procedure for distal ureteric stones in a bilharzial ureter with hydronephrosis.
确定腹腔镜治疗血吸虫性输尿管中嵌顿性远端输尿管结石的疗效和安全性。由于血吸虫卵在远端输尿管沉积导致远端狭窄，血吸虫性输尿管较为复杂。这些病例常伴有肾功能不佳和严重肾积水，这会妨碍对同时存在的远端大量嵌顿性结石及长期结石进行内镜操作。
我们采用四孔腹腔镜输尿管切开取石术治疗51例患有远端输尿管结石的血吸虫病患者（33例男性和18例女性；平均年龄40.13岁）。在结石上方直接切开输尿管并取出结石。将一根双J支架置入输尿管，然后用4-0聚乙醇酸连续缝线缝合输尿管。
结石平均大小为2.73厘米。仅1例患者需要转为开放手术。平均手术时长为92分钟，术后疼痛评分为20 - 60分，术后平均（范围）止痛需求次数为1.72次（1 - 3次），其中21例患者需要1次，23例患者需要2次，7例患者需要3次。平均住院时间为2.74天，总随访时长为7 - 12个月。4例患者结石复发，2例报告有输尿管狭窄。所有患者结石均清除。
对于伴有肾积水的血吸虫性输尿管远端输尿管结石，腹腔镜手术是一种安全有效的微创手术。
