联合应用多种内腔镜一期诊断和治疗早期肾盂癌(附8例报告)

Combined with Multiple Endoscopes for Diagnosis and Treatment of Early Renal Pelvic Carcinoma(Report of 8 Cases)

目的:探讨多种内腔镜在早期肾盂癌诊断和治疗中的联合应用价值。方法:8例肾盂癌患者运用输尿管软硬镜或经皮肾镜诊断,并一期采用后腹腔镜联合经尿道输尿管切开.行肾输尿管全长切除及膀胱输尿管开口袖套状切除。术后病理诊断为G_15例,G_23例,T_1N_0M_05例,T_2N_0M_03例。结果:8例均顺利完成手术,手术时间平均150 min,术中出血量平均120 ml。导尿管留置时间为7天左右,术后2～4天下床活动。均无漏尿、切口感染等并发症。仅1例因淋巴漏,皮管引流至术后2周拔除。随访6～18个月,患者均无瘤生存.未见肿瘤复发、转移及切口肿瘤种植。结论:通过联合应用多种内腔镜,可以在明显提高肾盂癌的诊断率的基础上,一期完成腹腔镜肾盂癌根治性切除,最大限度地减少患者手术创伤和手术并发症。

Objective： To evaluate the clinical value of combined with multiple endoscopes for diagnosis and treatment of early renal pelvic carcinoma. Methods：8 patients with renal pelvic carcinoma were diagnosed by ureteroscope （rigid/flexible） or percutaneous nephroscope, total nephroureterectomy with excision of bladder cuff by retroperitoneal laparoscopy plus transurethral resection were performed one-stage in them. The pathology after op- eration proved that 5 patients were grade Ⅰ, 3 were grade Ⅱ 5 were T1 N0 M0, and 3 were T2 N0 M0. Results： The operation was successfully performed in 8 patients. The average time of operation was 150min, the average bleeding during operation was 120 ml. In dwelling urethral catheter time ranged 7 d, postoperative activity out of bed days ranged 2 4 d. No complications such as leakage of urine, infection of incisional wound occurred. 1 case got lymphorrhagia and the rubber drainage tube was removed in 2 weeks after operation. There was no tumor recurrence or metastasis or implantation in all these patients after follow-up of 6-18 months. Conclusions： The accuracy of early diagnosis of renal pelvic carcinoma was obviously improved by combined with multiple endoscopes, and retroperitoneal laparoscopic renal pelvic carcinoma radical resection could be performed one-stage, thus the surgical trauma and the postoperative complications were reduced maximally.