完全腹腔镜下肾输尿管全切除术(附9例报告)

Totally transperitoneal laparoscopic nephroureterectomy (reports of 9 cases)

目的探讨完全腹腔镜下肾输尿管全切除的手术方法.方法该组9例.男6例,女3例.采用完全腹腔镜手术方法行肾输尿管全切除术.气管内插管全麻,侧卧位.首先采用3、4个套管经腹入路行腹腔镜下肾及肾周脂肪囊整块切除.然后将体位转成45°斜卧位,用超声刀将输尿管向下分离至膀胱壁外,提拉输尿管末段,绕其根部2 cm切除膀胱壁及输尿管开口.用2-0 Dexon线缝合膀胱切口.将肾输尿管放入标本袋内取出.结果该组病例全部顺利完成手术.手术时间180～240min,平均210min.出血量150～250ml,平均180ml,无明显围手术期并发症.术后随访2～34个月,未见肿瘤种植转移及膀胱肿瘤发生.结论完全腹腔镜肾输尿管全切除术可进一步减少手术创伤,更加符合肿瘤根治原则,减少并发症.随着腹腔镜技术及设备的不断完善,该术式将越来越广泛地应用于临床.

Objective: To evaluate totally laparoscopic nephroureterectomy by transperitoneal approach. Methods: From June 2001 to February 2004, nine patients were performed totally transperitoneal laparoscopic nephroureterectomy, including six males and three females. The operations were done under general anesthesia and the patients were placed in lateral decubitus position. En bloc excision of the kidney and perirenal fat were performed first by transperitoneal laparoscopy via three or four ports. Then the patients were placed in 45-degree decubitus position. The ureter was separated to the distal partition with harmonic scalpel. Once the distal ureter was pulled cephalad, the complete distal ureter, with bladder cuff, was removed en bloc. And the bladder incision was sutured with absorbable suture. All specimens were extracted intact. Results: Laparoscopic procedures were complete in all the cases. The mean (range) operating time was 210 minutes (180~240 minutes). And the mean (range) blood loss was 180 ml (150~250 ml). There was no intraoperative or postoperative complication in all cases. No implantation metastasis or bladder neoplasis was detected. Conclusions: Totally transperitoneal laparoscopic nephroureterectomy will reduce the surgical tissue damage greatly, and it achieves the principles of surgical oncology. With the improvement of laparoscopic technique and instrument, totally laparoscopic nephroureterectomy will be more and more popular on clinical purpose.