[1]温机灵,陆佳荪,仇广明,等.后腹腔镜输尿管切开取石术后迟发性尿漏的因素分析及处理[J].中国微创外科杂志,2017,17(5):425-427.
　Wen Jiling,Lu Jiasun,Qiu Guangming,et al.Analysis and Treatment of Delayed Urinary Leakage After Retroperitoneal Laparoscopic Ureterolithotomy[J].Chinese Journal of Minimally Invasive Surgery,2017,17(5):425-427.
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后腹腔镜输尿管切开取石术后迟发性尿漏的因素分析及处理()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年5期
页码:
425-427
栏目:
临床研究
出版日期:
2017-07-14

文章信息/Info

Title:
Analysis and Treatment of Delayed Urinary Leakage After Retroperitoneal Laparoscopic Ureterolithotomy
作者:
温机灵; 陆佳荪; 仇广明; 王学雷; 李容炳; 沈林洁; 朱蔚①; 温晓飞**
同济大学附属东方医院泌尿外科，上海200120
Author(s):
Wen Jiling;  Lu Jiasun;  Qiu Guangming;  et al.
Department of Urology, East Hospital of Tongji University School of Medicine, Shanghai 200120, China
关键词:
输尿管结石; 腹腔镜; 尿漏
Keywords:
Ureteral stone; Laparoscopy; Urinary leakage
文献标志码:
A
摘要:
目的探讨后腹腔镜输尿管切开取石术后发生迟发性尿漏的原因及处理方案。方法2012年12月~2015年12月，我科102例嵌顿性输尿管上段结石行后腹腔镜输尿管切开取石术，其中3例在拔除腹膜后引流管1周后发生迟发性尿漏，均表现为切口漏尿，3例均长期服用激素（泼尼松）或细胞毒药物（甲氨蝶呤）。结果3例均经B超引导下经皮肾穿刺造瘘引流，1周后顺行造影提示无尿外渗，拔除肾造瘘管后无尿漏，术后6周拔除双J管，随访6、25、42个月，无输尿管狭窄发生。长期服用激素或细胞毒药物的患者迟发性尿漏发生率显著升高（3/3 vs. 0/99，Fisher检验，P=0.000）。结论长期服用激素或细胞毒药物可能是输尿管切开取石术后发生迟发性尿漏的危险因素，经皮肾穿刺造瘘引流是首选的治疗方案。
Abstract:
ObjectiveTo investigate the causes and treatment of delayed urinary leakage after retroperitoneal laparoscopic ureterolithotomy.MethodsA total of 102 cases of impacted upper-ureter calculi were treated by retroperitoneal laparoscopic ureterolithotomy from December 2012 to December 2015. Three cases after pulling out peritoneal drainage tube suffered delayed urinary leakage which manifested leakage of urine from incision. All the three cases were given hormones (prednisone) or cell cytotoxic drugs (methotrexate) for a long time. ResultsThe 3 patients were treated by percutaneous nephrostomy under B-ultrasound guidance. Antegrade pyelography was performed to confirm that there was no urine leakage one week later, and then the nephrostomy tube was removed. The 3 patients were followed up for 6, 25 and 42 months with no ureteral stenosis occurred. The difference was statistically significant between the cases who were given hormones/cell cytotoxic drugs for a long time and who weren’t (3/3 vs. 0/99, Fisher’s Exact Test, P=0.000).ConclusionLong-term use of hormone or cytotoxic drugs may be a risk factor for occurrence of delayed urinary leakage after laparoscopic ureterolithotomy. Percutaneous nephrostomy is the best treatment for delayed urinary leakage.

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备注/Memo

备注/Memo:
基金项目：上海市浦东新区科技发展基金创新资金（PKJ2013-Y21）**通讯作者，E-mail：wenxiaofei1972@163.com①手术室
更新日期/Last Update: 2017-07-14