【正文】
,。經(jīng)腹和經(jīng)腹膜后途徑術(shù)中出血、手術(shù)時(shí)間、并發(fā)癥發(fā)生率均無顯著差異。開放或腹腔鏡輸尿管切開取石適應(yīng)證為:1)大且致密堅(jiān)固的輸尿管結(jié)石。ng)總結(jié),課程題目:腹腔鏡輸尿管切開取石術(shù) 內(nèi)容提要:腹腔鏡輸尿管切開取石術(shù)適應(yīng)證 和手術(shù)相關(guān)(xiāngguān)問題。,內(nèi)容(n232。,ESWL后,82,第八十二頁,共八十四頁。sh237。,思 考,DJ管 引流 冷刀或電刀 縫合輸尿管 下面2種情況首選(shǒu xuǎn)什么治療,80,第八十頁,共八十四頁。ngl236。ng)穿刺點(diǎn)(右側(cè)),78,第七十八頁,共八十四頁。,經(jīng)腹途徑(t,經(jīng)腹途徑穿刺(chuānc236。ngh233。,手術(shù)(shǒush249。sh237。,74,第七十四頁,共八十四頁。o),保守治療后緩解。3例尿漏,均保持引流通暢后自愈,一例嚴(yán)重血尿(xu232。均經(jīng)腹腔途徑,保留DJ管,間斷縫合輸尿管。n)的經(jīng)驗(yàn),腹腔鏡輸尿管上段切開取石術(shù)的技巧及并發(fā)癥的處理 臨床泌尿外科雜志,2012,27(4),291293(通訊作者:孫立安) 摘要: 目的:探討腹腔鏡輸尿管切開取石術(shù)的手術(shù)技巧及常見并發(fā)癥的處理。,73,第七十三頁,共八十四頁。o)的前提。 腹腔鏡及縫合技術(shù)的訓(xùn)練和經(jīng)驗(yàn)積累,是滿意療效(li225。 作為二線治療,LUL是ESWL與URS的有效補(bǔ)救措施,但結(jié)石取凈率更高。ngji224。)1cm),第七十二頁,共八十四頁。187(1):164168(注:large 結(jié)石(ji233。n chu225。,EAU Guidelines on Urolithiasis,In 2001, analysis of the relevant literature for the 3 years after the AUA publication semirigid and flexible ureteroscopes provided a 90% to 100% stonefree rate for distal ureteral calculi and a 74% stonefree rate for proximal ureteral calculi. 95% of patients could be successfully treated with only one endoscopic procedure,71,第七十一頁,共八十四頁。,The AUA Ureteral Stones Clinical Guidelines Panel,Articles on ureteral calculi published during a 30year period from 1966 to 1996 . The stonefree rates of SWL and ureteroscopy were 72% 84% and 44%56%, respectively, for stones smaller or larger than 1 cm. The risks of significant complications after SWL and ureteroscopy were 4% and 11%, respectively. Open stone surgery had a median stonefree rate of 97%.,70,LUL與SWL和URS的比較(bǐji224。,主要(zhǔy224。,療 效,中轉(zhuǎn)率: 主要原因:結(jié)石漂移、RPF及后腹腔空間小 7.9%,多為早期(zǎoqī)手術(shù)病人。,療 效,一次結(jié)石取凈率:接近100% 高于ESWL和URS 結(jié)石取凈率與結(jié)石大小無關(guān)(wngl236。)引流管,65,第六十五頁,共八十四頁。,放置(f224。ngh233。,置雙J管,63,第六十三頁,共八十四頁。,切開輸尿管,61,第六十一頁,共八十四頁。,顯露(xiǎnl249。,顯露(xiǎnl249。ul237。ng)取石場景,57,第五十七頁,共八十四頁。,經(jīng)腹途徑(tj236。)體位,55,第五十五頁,共八十四頁。)引流管,54,第五十四頁,共八十四頁。,放置(f224。ngh233。,置雙J管,52,第五十二頁,共八十四頁。)輸尿管至結(jié)石部位,50,第五十頁,共八十四頁。,游離(y243。ul237。)氣腹方法,檢查