腹腔镜及开放根治性肾输尿管膀胱切除术治疗上尿路肿瘤合并膀胱癌8例报告

Radical nephroureterectomy and partial cystectomy for upper urinary tract and bladder tumor by laparoscopic combined open surgery(8 cases report)

目的探讨腹腔镜和开放根治性肾输尿管膀胱切除术治疗上尿路肿瘤合并膀胱癌患者的可行性和安全性。方法收集我院2004年6月至2009年3月期间收治的8例单侧上尿路肿瘤并浸润性膀胱癌行根治性肾输尿管膀胱切除术及尿流改道手术患者的临床资料并进行随访分析。结果本组8例。男7例,女1例,平均年龄56岁。术前经膀胱镜、输尿管镜、B超和CT等检查证实为单侧上尿路肿瘤并浸润性膀胱癌,其中4例左肾盂癌和2例右肾盂癌合并膀胱癌,2例为左输尿管癌合并膀胱癌。2例行腹腔镜肾输尿管膀胱切除术及回肠膀胱术,平均手术时间470min,术中平均出血量275ml,均无输血,术后肠功能恢复时间为2d,下床活动时间为4d。6例患者行开放肾输尿管膀胱全切除术,其中4例行回肠膀胱术,另2例行输尿管造口术,平均手术时间366min,平均出血量767ml,平均输血量485ml,术后肠功能恢复时间为3.3d,下床活动时间平均为6.7d。8例患者术后均未出现并发症。术后病理结果 7例为尿路上皮癌,上尿路肿瘤分期分级为T2～4N0～1M0G2,膀胱癌为T2～3N0M0G3,另1例为左肾盂鳞癌T4N1M0合并膀胱鳞癌T3N0M0。术后平均随访24.6个月,鳞癌患者术后18个月因肿瘤广泛转移死亡,余7例患者无瘤生存至今。结论单侧上尿路肿瘤合并膀胱癌可行Ⅰ期根治性肾输尿管膀胱切除术,腹腔镜下行该手术是可行及安全的,较开放手术创伤小,出血少,恢复快。

Objective To evaluate the safety and availability of laparoscopic and open radicalnephroureterocystectomy to the patients with tumors of upper urinary tract complicating with bladder cancer.Methods Followed up 8 patients from June 2004 to March 2009 who had been performed radical nephroureterocytectomy due to the tumors of unilateral upper urinary tract complicating with invasive bladder cancer and made an analysis.Results There were 7 males and 1 female in the group,with average age of 56.They were all diagnosed as tumor of unilateral upper urinary tract complicating with invasive bladder cancer by cystoscope,ureteroscope,ultra-sound or CT.Among these 8 patients,4 were left and 2 were right renal pelvic cancer complicating with bladder cancer,2 patients were left ureteral cancer complicating with bladder cancer.2 patients were performed the operation of laparoscopy radical nephroureterocystectomy and bricker operation,with the average operation time was 470 min and average bleeding volume was 275 ml without blood transfusion.And the recovery time of alimentary tract and the time of free activity were 2 days and 4 days.The other 6 patients were made the operation of open radical nephroureterocystectomy,4 of which were make the bricker operation and the other 2 were ureterostomy,with the average operation time was 366 min and average bleeding volume was 767 ml.And the recovery time of alimentary tract and the time of free activity were 3.3 days and 6.7 days.No overt complications were observed from these 8 patients.Postoperative pathological results showed that 7 slides were urothelial tumors with tumor stage of upper urinary tract T2-4N0-1M0G2 and tumor stage of bladder cancer T2-3N0M0G3,and the other 1 slide was squamous cell carcinoma of left renal pelvis and bladder,with tumor stage of renal pelvis T4N1M0 and tumor stage of bladder cancer T3N0M0.mean time of follow-up was 24.6 months,the patient with squamous cell carcinoma died off after 18 months and the others were survival without tumor recurrence.Conclusions Nephroureterocystectomy is available to tumor of unilateral upper urinary tract complicating with bladder cancer.The operation under laparoscopy is available and safe,with less trauma and bleeding and faster recovery.