Harewood L M, Webb D R, Pope A J
Department of Urology, Royal Melbourne Hospital, Victoria, Australia.
Br J Urol. 1994 Aug;74(2):170-6. doi: 10.1111/j.1464-410x.1994.tb16581.x.
To evaluate the place of laparoscopic ureterolithotomy in the management of ureteric calculi for which extracorporeal shockwave lithotripsy (ESWL) and endourological techniques are unsuitable.
Laparoscopic ureterolithotomy was attempted in nine patients (eight men, one woman) with an age range of 26-81 years (mean 55.5) who had large, long standing and impacted calculi in the upper and mid ureter. The stone size ranged from 5 to 28 mm (mean 13.2) and stone duration ranged from one to 24 months (mean 8.2). The transperitoneal route was used in six patients and the extraperitoneal route in three but was converted to a transperitoneal approach in two.
The stone was successfully removed in all nine patients. The operative time ranged from 80 to 260 minutes (mean 158). No intra-operative complication was encountered and no patient required a blood transfusion. Post-operative complications included urinary leak and fever. The post-operative stay ranged from 2 to 13 days (mean 5.2).
Laparoscopic ureterolithotomy has definite advantages over open ureterolithotomy. Furthermore, the more difficult a stone is for treatment by ESWL and endourological techniques, the more suitable it is for laparoscopic removal. For large, hard, long-standing and impacted ureteric calculi, one laparoscopic ureterolithotomy as initial therapy may be preferable to multiple endourological and ESWL procedures.
评估腹腔镜输尿管切开取石术在处理体外冲击波碎石术（ESWL）和腔内泌尿外科技术均不适用的输尿管结石中的地位。
对9例患者（8例男性，1例女性）尝试进行腹腔镜输尿管切开取石术，年龄范围为26 - 81岁（平均55.5岁），这些患者的输尿管上段和中段存在大的、长期存在且嵌顿的结石。结石大小为5至28毫米（平均13.2毫米），结石存在时间为1至24个月（平均8.2个月）。6例患者采用经腹途径，3例采用腹膜外途径，但其中2例转为经腹途径。
所有9例患者的结石均成功取出。手术时间为80至260分钟（平均158分钟）。术中未发生并发症，无患者需要输血。术后并发症包括尿漏和发热。术后住院时间为2至13天（平均5.2天）。
腹腔镜输尿管切开取石术相对于开放输尿管切开取石术具有明显优势。此外，结石越难以通过ESWL和腔内泌尿外科技术治疗，就越适合通过腹腔镜取出。对于大的、坚硬的、长期存在且嵌顿的输尿管结石，将腹腔镜输尿管切开取石术作为初始治疗方法可能优于多次腔内泌尿外科手术和ESWL治疗。
