后腹腔镜手术联合下腹部斜切口治疗输尿管癌

Posterior Laparoscopic Surgery Combined with Bypogastrium Oblique Incision for Ureter Cancer

目的:探讨后腹腔镜联合下腹部斜切口治疗输尿管癌的手术方法及其临床效果。方法:本组患者均采用气管插管麻醉。首先,采用下腹部斜切口将输尿管下段和膀胱壁段输尿管及膀胱内输尿管开口周围1cm的膀胱全层切除(膀胱袖口状切除),再将患者改为健侧卧位(同肾切除术体位),在腹腔镜下行患肾切除术。将切除之肾脏放入标本袋,拆除下腹切口的缝线,自原下腹斜切口将患肾取出。结果:手术时间为150～180min,平均为140min;术中出血量为10～60ml,平均为20ml。肠道恢复时间为术后1～3天,平均为1.5天。术后2～4天开始进食。手术后7～10天痊愈出院。手术后病理报告:12例均为输尿管移行细胞癌Ⅰ～Ⅱ级,侵及固有膜。术中和术后均未发生并发症。术后随访1～19个月,一般状况均良好,无肿瘤复发及转移。结论:后腹腔镜手术联合下腹斜切口治疗输尿管癌,具有创伤小、解剖清晰、术中出血少、术后恢复快等优点,是一种安全、有效的治疗方法。

Objective： To investigate the surgical technique and clinical effectiveness of Posterior Laparoscopic surgery combined with hypogastrium oblique incision for ureter cancer. Methods： All of the patients remained prostrate after general anaesthesia was administered and a hypogastrium oblique incision was employed to remove an inferior segment of the ureter including a 1 cm circle of bladder surrounding the ureter orifice. Then the patient was moved to a reclining position on the uninjured side to perform the posterior laparoscopic surgery. Put the sample into the self-command sample bag, then take out the renal by the incision. Results： Operating time was 150 to 180 minutes （median 140 rains） and blood loss was 10 to 60ml （median 20 ml）. Food intake was started on hospital day 1-3 （median 1.5 days） and patient discharge from the hospital was 7-10 days after surgery. Histopathological examination of the specimens revealed all of the patients had transitional cell carcinoma grade Ⅰ - Ⅱ. Follow up continued for 1-19 months （median 8 mouths） after surgery without recurrence or metastasis. Conclusion： Posterior Laparoscopic surgery combined with hypogastrium oblique incision for ureter cancer uses a small incision, incurs less blood loss, and allows for a more rapid recovery, suggesting it is a safe and effective method for treating patients with ureter cancer.