我們以改進之後腹腔鏡輸連管截石術成功地處理了七位中的五位嵌塞在上段輸尿管的結石病患。我們對以往手術方式的改進之處在於：1.在後腹腔鏡手術中，不再改變體位，在直視下將輸連管雙丁導管調整到最佳的位置。2.在內視鏡直視下，將輸尿管切口以腔內縫合並打結的方式予以關閉。所有五至病人出院時均無體外之引流管。這五位病人手術前後的資料並與十位進行傳統上輸尿管截石術的病人加以比較。平均手術時間(2.1及3.45 小時)以傳統開刀方式較快(P<0.05)。失血量上兩組之間無明顯差距。術後需要的針注止痛劑量(60及175毫克之meperidine hydrochloride)以後腹腔鏡組較少。術後的住院天數(3.8及8.9天)，及康復到日常生活(9.5及24天)也以後腹腔鏡組較快(三者均p<0.05)。我們的結論是改進之後腹腔鏡輸連管截石術因其侵襲性小，很適合用來治療原來打算以傳統開刀方式處理的上輸尿管結石。

Retroperitoneoscopic ureterolithotomy was successfully performed in five of seven patients with calculi impacted in the upper ureter. Our modifications of previously reported procedures included well adjustment of the position of the double-J ureteral stent under direct vision during the retroperitoneoscopic surgery without further posture change and suturing the ureterotomy incision with intracorporeal knotting. All these 5 patients were discharged without carrying ex-ternal tubes or bags. Peri-operative parameters in these successful cases were compared with those in 10 cases of traditional open ureterolithotomy. The average operative time was shorter (2.1 vs. 3.45 hours; P< 0.05) for the open ureterolithotomy group. The amount of mean blood loss did not differ between these two groups. The need for post-operative parenteral analgesics (60 vs. 175 mg of meperidine hydrochloride) was less; and post-operative hospital stay (3.8 vs. 8.9 days) and convalescence to regulao daily activities (9.5 vs. 24 days) were much faster in the retroperitoneoscopic group (all P< 0.05). Retroperitoneoscopic ureterolithotomy, with its mini-mal invasiveness, is a valuable alternative in the management of upper ureteral stones, especially when open ureterolithotomy is indicated. (J Urol R.O.C., 9:186-190,1998)