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目的:探讨后腹腔镜与开放手术治疗输尿管上段结石的疗效情况。方法:收治79例患者,随机分成2组。其中后腹腔镜输尿管上段切开取石(LS)36例,开放手术输尿管上段切开取石(OS)43例。LS组采用气管插管全麻,OS组采用腰硬联合麻。两组病例均放置双J管。将手术时间、出血量、术后下床活动时间、术后止痛剂运用情况、腹膜后伤口引流管留置时间、术后住院时间进行对比研究。结果:两组手术均获得成功。手术时间LS组65~210min,平均106 min;OS组40~105min,平均60 min(P<0.01)。出血量LS组15~40 mL,平均24 mL;OS组35~130 mL,平均90 mL(P<0.01)。术后下床活动时间LS组15~30h,平均23 h;OS组40~58 h,平均49 h(P<0.01)。术后止痛剂运用例数LS组9例;OS组38例(P<0.01)。腹膜后伤口引流管留置时间LS组72~120 h,平均96 h;OS组60~126 h,平均92 h(P>0.05)。术后住院时间LS组6~8d,平均7.0 d;OS组9~13 d,平均11 d(P<0.05)。两组病例术后均留置导尿管6~7 d;均在术后4w拔除双J管。结论:后腹腔镜输尿管上段切开取石术与开放手术相比它具有出血量少、术后伤口疼痛轻、住院时间短、创伤小、恢复快等优点。但它手术时间长、费用高、要一定的腹腔镜操作经验。
Objective: To investigate the effect of retroperitoneal laparoscopy and open surgery in the treatment of upper ureteral calculi. Methods: 79 patients were treated and randomly divided into 2 groups. Among them, there were 36 cases of upper laparoscopic ureterolithotomy (LS) and 43 cases of upper ureteral incision (OS). LS group tracheal intubation general anesthesia, OS group using waist and hard joint anesthesia. Two groups of patients were placed double J tube. The operation time, bleeding volume, postoperative ambulation time, the use of analgesics after surgery, retroperitoneal wound drain indwelling time, postoperative hospital stay were compared. Results: Both procedures were successful. The operative time was 65 ~ 210min in LS group, with an average of 106 min. The OS group was 40 ~ 105min, with an average of 60 min (P <0.01). The bleeding volume was 15 ~ 40 mL in LS group, 24 mL in average, and 35 ~ 130 mL in OS group, with an average of 90 mL (P <0.01). The time of getting out of bed after operation was 15 to 30 hours in LS group, an average of 23 hours and 40 to 58 hours in OS group, with an average of 49 hours (P <0.01). There were 9 cases in LS group and 38 cases in OS group (P <0.01). The retroperitoneal wound drainage catheter placement time was 72-120 h in LS group, 96 h in OS group, and 92 h in OS group (P> 0.05). The postoperative hospital stay was 6 to 8 days in LS group, with an average of 7.0 days. The OS group was 9 to 13 days with an average of 11 days (P <0.05). Two groups of patients were placed after catheter catheter 6 ~ 7 d; were removed after 4w double J tube. Conclusions: Retroperitoneal laparoscopic ureterolithotomy has the advantages of less bleeding, less postoperative wound pain, shorter hospital stay, less trauma and faster recovery than open surgery. But it is a long operation, high cost, to a certain degree of laparoscopic operating experience.