联合腔镜肾输尿管全切除术13例报告

Retroperitoneoscopic nephroureterectomy combined with transurethral excision of bladder cuff

目的探讨联合腔镜肾输尿管全切除术治疗上尿路移行细胞癌(TCC)的临床价值。方法对13例上尿路TCC患者施行联合腔镜肾输尿管全切除术。手术先取截石位,经尿道应用电切镜行患侧输尿管开口环切,再改健侧卧位,行后腹腔镜肾输尿管全长切除。结果13例手术顺利,手术时间120～210 min,平均150min,术中出血60～320 mL,平均108 mL,无术中输血者;术后24 h即可下床活动,16～24 h肛门排气,切口引流放置2～4 d,术后留置导尿7～8 d。病理报告移行细胞癌13例,伴鳞状细胞癌1例。术后随访3～40个月,1例于术后6月发现肿瘤转移,1例于术后1.5年死亡,余11例无复发或转移。结论联合腔镜肾输尿管全切术具有创伤小,并发症少,术后恢复快、住院时间短等优点,是上尿路TCC的有效微创手术治疗方法,值得临床选用。

[Objective] To report our experience with retroperitoneoscopic nephroureterectomy combined with transurethral excision of bladder cuff for renal pelvic and uretal tumors. [Methods] Totally 13 patients with upper urinary tract tumors underwent retroperitoneoseopie nephroureterectomy combined with transurethral excision of bladder cuff. Of the 13 cases, 10 are male and 3 are female; their age ranged from 48 to 72 years with the mean of 61 years. First, patients lay in supine position, needle electrode was used to circularly incise the bladder thoroughly 0.5 cm away from the ureterostoma; then they changed to the side-lying position, three trocars in the waist were used for dissecting the kidney and ureter. [Results] The operation was successful in all 13 patients. The mean operative time was 150 min （range, 120-210 min）. The patient＇s activity recovered in 24 h after operation. The mean estimated blood loss was 108 mL （range, 60-320 mL）. No ease received blood transfusion. Postoperative pathology showed transitional cell carcinoma in all 13 cases, accompanied with squamous cell carcinoma in 1 ease. The mean hospital stay was 7-9 d. During a mean follow-up of 26 months （range, 3-40 months）, 1 patient developed multiple metastasis and was dead in 1.5 years, another was found recurrence in the renal back and is still alive with the tumor now. Eleven patients have survived free of tumor to date. [Conclusions] Retroperitoneoseopie nephrouretereetomy combined with transurethral excision of bladder cuff has shorter incision and more rapid postoperative recovery compared with open surgery. It is an ideal surgical technique for renal pelvic and uretal tumors.