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目的:对经脐单孔腹腔镜(laparoendoscopic single-site surgery,LESS)输尿管切开取石术的取石、置管和缝合打结方法进行改良,探讨其治疗输尿管上段结石的安全性、有效性及优势。方法:2015年7月~2016年12月,采用改良经脐LESS输尿管切开取石术治疗输尿管上段结石16例,其中男10例,女6例;年龄22~66岁,平均46.25岁;左侧9例,右侧7例;结石最大直径平均1.6cm,均伴不同程度肾积水。记录手术时间、术中出血量、结石清除率、引流管留置时间、术后镇痛药应用情况及术后住院时间等。结果:16例手术均获成功,结石清除率100%。平均手术时间74(60~115)min,平均术中失血量36(20~60)ml,术后肠道恢复时间24~36h,平均引流管留置时间3d,平均术后住院时间3d。仅1例术后需静脉注射镇痛药1次。随访1~17个月,16例肾积水均获改善,无结石复发,无输尿管狭窄及严重并发症发生。结论:改良经脐LESS输尿管切开取石术治疗输尿管上段结石疗效确切,术程简便,术后疼痛轻微、住院时间短,美容效果满意,值得临床应用。
OBJECTIVE: To improve the safety, effectiveness and advantages of ureteral calculi in the treatment of laparoscopic single-site surgery (LESS) with ureteral stone removal, catheterization and suture knotting . Methods: From July 2015 to December 2016, 16 cases of upper ureteral calculi were treated with modified transabdominal LESS ureterolithotomy, including 10 males and 6 females, aged 22-66 years with an average of 46.25 years old. The left side 9 cases, right in 7 cases; the largest diameter of the average stone 1.6cm, with varying degrees of hydronephrosis. The operation time, intraoperative blood loss, stone clearance rate, drainage tube indwelling time, postoperative analgesic application and postoperative hospital stay were recorded. Results: All the 16 surgeries were successful. The stone clearance rate was 100%. The mean operative time was 74 (60-115) min, the average blood loss was 36 (20-60) ml, the postoperative intestinal recovery time was 24-36 hours, the average drainage tube was placed for 3 days, and the average postoperative hospitalization time was 3 days. Only 1 patient required intravenous analgesic 1 time after operation. Followed up for 1 to 17 months, 16 cases of hydronephrosis were improved, no recurrence of stones, no ureteral stricture and serious complications. Conclusion: The modified transabdominal lithotripsy with LESS ureterolithotomy is effective in the treatment of upper ureteral calculi. The procedure is simple, the postoperative pain is mild, the length of hospital stay is short, and the cosmetic effect is satisfactory. It is worthy of clinical application.