腹膜腹腔镜根治性肾输尿管切除治疗上尿路移行细胞癌

Radical nephroureterctomy of retroperitioneal laparoscopic for upper tract transitional cell carcinoma

目的:探讨后腹腔镜手术治疗上尿路移行细胞癌的手术方法。方法:采用后腹腔镜手术治疗上尿路移行细胞癌21例,其中肾盂癌14例,输尿管癌7例,右侧11例,左侧10例,男13例,女8例,年龄36￣72岁,平均41岁.病理分期:A期15例,B期6例。病理分级:GradeI7例,GradeII9例,GradeIII5例。结果:手术成功20例,1例因术后出血改开放手术。手术时间100-360min,平均210min。术中出血85￣320ml,平均146ml,术中均未输血。患者术后1￣3天恢复排气并进食,2天后下床活动。术后住院时间4￣12天,平均7天。术后随访1￣30个月,无肿瘤复发,丝裂霉素间断膀胱灌注。结论:后腹腔镜根治性肾输尿管切除术手术创伤小,疼痛轻,康复快,有可能成为上尿路移行细胞癌的主要手术方法。

Objective：To evaluate the retroperitioneal laparoscopic radical nephroureterctomy for upper tract transitional cell carcinoma. Methods： From June 2001 to May 2004, a total of 21 patients （13 male,8 female：11 right,8 left） underwent radical nephroureterectomy for pathologically confirmed upper tract transitional cell carcinoma. The mean age was 41 （36-72） years. There were 14 cases with upper tract transitional cell carcinoma from pelvis, 7 cases from ureter; 15 cases with stage A,while 6 cases with stage B, and 7 cases with grade Ⅰ, 9 cases with grade Ⅱ and 5 cases with grade Ⅲ. Results：Twenty cases underwent retroperitoneal laparoscopic radical nephroureterctomy successfully without complications. The procedure was converted to open operation in 1 case because of bleeding after operation. The mean operation time was 210 min （100-360 min）, and the mean amount of bleeding was 146 ml （85-320 ml） with no need of transfusion. The postoperative in-hospital time was 7d （4-12 d）, After 1 to 30 months＇ follow- up, there was no tumor recurrence by using bladder chemotherapy of mitomicin. Conclusion：Retroperitioneal laparoscopic radical nephroureterctomy is less traumatic to the patients with less postoperative discomfort and quicker rehabilitation. It appears that retroperitioneal laparoscopic radical nephroureterctomy may be the main treatment method for upper tract transitional cell carcinoma.