电切镜与腹腔镜联合治疗累及输尿管口的浅表性膀胱肿瘤

Combined iaparoscopic technique for superficial bladder neoplasms involved orifice

目的探讨电切镜与腹腔镜联合治疗累及输尿管开口的浅表性膀胱肿瘤的治疗效果。方法累及输尿管开口的浅表性膀胱肿瘤患者12例。男7例，女5例。平均年龄46岁。肿瘤直径0．8～3．0cm。TNM分期Tis 6例、T1 6例。采用经尿道膀胱肿瘤切除术，切除肿瘤及肿瘤周围0．5～1．0cm正常膀胱黏膜（包括输尿管开口），深达浅肌层；再应用腹腔镜技术进行膀胱输尿管再植。结果12例患者手术顺利。平均手术时间2．2h，平均出血量25m1。术后3个月拔除双J管，膀胱镜检示输尿管乳头形态良好。术后6个月行IVU及膀胱排泄性造影，输尿管无梗阻，Ⅰ～Ⅱ度输尿管反流2例。术后1年膀胱造影，Ⅰ～Ⅱ度输尿管反流4例，Ⅱ度输尿管反流3例。随访3～24个月，B超和IVU显示中度肾积水1例、轻度肾积水5例。结论联合腔内技术治疗累及输尿管开口的浅表性膀胱肿瘤是微创、安全有效的手术方法，适于基层医院开展。

Objective To assess clinical efficacy of the combined laparoscopic technique for superficial bladder neoplasms involved ureteric orifice. Methods A total of 12 patients with bladder neoplasms involved ureteric orifice were treated and reviewed. The clinical tumor stage was Tis in 6, T1 in 6. During the procedure, the transurethral resection of bladder neoplasms was performed firstlythe extent including 0.5-1.0 cm formal bladder tissue around ureteric orifice, deep to superficial muscle of bladder, then ureteroneocystostomy was clone with transperitoneal laparoscopic technique. Results The operations were successfully in all 12 cases. The average procedure time was 2.2 h. The average volume of hemorrhage was 25 ml. The double J stents were removed 3 months postoperatively. Six months after surgery intravenous pyelography （IVU） and eystography showed no ureter obstruction in all cases, Ⅰ--Ⅱ degree vesiele-ureteral reflux in 2 cases. One year after surgery custog raphy showed Ⅰ--Ⅱ degree vesiele-ureteral reflux in 4 cases, Ⅱ degree relux in 3 cases. During 3 24 months＇ follow up, B type ultrasound and IVU showed moderate hydronephrosis in 1 case, mild in 5. Conclusion The treatment of combining laparoscopic technique for superficial bladder neoplasms involved ureterie orifice might be an effective and safe method.