腹腔镜根治性肾输尿管切除术治疗上尿路肿瘤

Laparoscopic radical nephroureterectomy(Report of 26 cases)

目的 :评价腹腔镜根治性肾输尿管切除术治疗上尿路移行细胞癌的有效性和安全性。方法 :对 2 6例上尿路肿瘤患者 ,其中 2例曾有同侧肾移植史 ,行腹腔镜根治性肾输尿管切除及膀胱黏膜袖套状切除术 ,并记录其有关指标。结果 :2 6例均手术成功 ,其中 3例采用经腹腔途径 ,2 3例经后腹腔途径。平均手术时间 1 2 0min ,术中出血量 4 6ml,术后住院时间 1 0 .5d ,恢复正常活动时间 4 .1周。 2 0例随访 6～ 38个月 ,1例局部腹膜后肿瘤复发 ,1例膀胱内复发 ;无远处转移及穿刺通道的种植性转移。结论 :腹腔镜根治性肾输尿管切除术治疗上尿路移行细胞癌是安全、有效的微创手术方法 。

Purpose:To report our experiences of laparoscopic radical nephroureterectomy and evaluate its effectiveness and safety for upper tract transitional cell carcinoma.Methods:Between May 2000 and July 2002, 26 patients with upper tract transitional carcinoma underwent laparoscopic radical nephroureterectomy with excision of bladder cuff. The operative time, blood loss, postoperative hospital stay and the time to complete convalescence were estimated.Results:Among the 26 patient, 3 underwent transperitoneal laparoscopy, and the remaining 23 received retroperitoneal laparoscopic surgery. Mean operative time, blood loss, postoperative hospital stay and the time to complete convalescence were 120 min, 46 ml, 10.5 days and 4.1 weeks, respectively. The follow up period was 6～38 months. There was one case of recurrent retroperitoneal tumor, and one case of recurrent intravesical tumor. No distant metastasis and port site metastasis occurred.Conclusions:Laparoscopic radical nephroureterectomy is an effective and safe microinvasive surgery for the upper tract transitional cell carcinoma, but further study is necessary to determine its oncological outcomes.