| Objective To investigate the efficacy and safety of 3D laparoscopic surgery for ureteral stricture and summarize the experience.Methods A retrospective analysis was performed on 77 cases with ureteral stricture treated by laparoscopic surgery from December 2017 to December 2020.Among them,47 cases underwent 3D laparoscopic surgery（3D group）and 30 cases underwent 2D laparoscopic surgery（2D group）.There were 31 males and 16 females in the 3D group,28 cases on the left side and 19 cases on the right side,with an average age of（42.70±15.71）years.The position of the ureteral stricture: 28 cases at the upper ureter,6cases at the middle and 13 cases at the lower ureter part.The length of ureteral stricture ranged from（0.5-4.0）cm,with a average length of（1.44±0.74）cm,and the longest ureteral segment was 4.0 cm in the upper and middle segment and 2.5 cm in the lower segment.The degree of separation of the renal collecting system before surgery was（36.19±4.09）mm.Preoperative serum creatinine was（82.00±35.49）μmol/L.There were19 males and 11 females in the 2D group,17 cases on the left side and 13 cases on the right side,with an average age of（46.30±14.57）years.The position of the ureteral stricture: 18 cases at the upper ureter,5 cases at the middle and 7 cases at the lower ureter part.The length of ureteral stricture ranged from（0.5-3.0）cm,with a average length of（1.47±0.67）cm,and the longest ureteral segment was 3.0 cm in the upper and middle segment and 2.0 cm in the lower segment.The degree of separation of the renal collecting system before surgery was（34.27±4.74）mm.Preoperative serum creatinine was（86.40±36.94）μmol/L.The operation time,complications,intraoperative blood loss,postoperative hospital stays and patient satisfaction were collected and analyzed.Results All patients were successfully completed except for one case in the 2D laparoscopic group that was converted to open surgery.The average operation time of the 3D group was 132.87±27.64（min）and the 2D group was 148.67±24.49（min）,with significant difference（P<0.05）.The intraoperative blood loss of the 3D group was58.94±22.29（ml）,and the 2D group was 73.67±23.85（ml）,with significant difference（P<0.05）.Postoperative hospital stays of the 3D group was 7.81±1.74 days,and the 2D group was 7.33±1.42 days,with no significant difference（P>0.05）.In the 2D group,there was one case of incisional infection and 0 case in the 3D group,with no significant difference（P>0.05）.In the postoperative follow-up,there was one case of recurrence in the 2D group and 0 cases in the 3D group,with no significant difference（P>0.05）.The degree of separation of the renal collecting system and blood creatinine values at the last follow-up after surgery in both groups were statistically significant（P<0.05）compared with those before surgery,but there was no statistically significant difference between the two groups（P>0.05）.Satisfaction level: There were 2patients with the 3D group were very satisfied,44 were satisfied,and 1 was dissatisfied,and 0 was very dissatisfied,while 2 patients with the 2D group were very satisfied,26 were satisfied,1 was dissatisfied and 1 was very dissatisfied.It can be seen that patients were more satisfied with the treatment effect after the 3D group.The difference was not statistically significant（P>0.05）.Conclusion 3D laparoscopic surgery is a safe and effective method for treating ureteral stricture,which can effectively shorten the operation time and reduce intraoperative blood loss compared with the traditional 2D laparoscopic surgery.The use of 3D laparoscopic surgery for the treatment of patients with ureteral stricture has important clinical value and deserves further clinical research and use. |
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