肾盂癌根治术联合经尿道电切治疗肾盂癌(附22例报告)

Nephroureterectomy Combined with Transurethral Resection of the Intramural Ureter and Bladder Cuff for Renal Pelvic Carcinoma (A Report of 22 Cases)

目的:探讨肾盂癌根治术联合经尿道电切治疗肾盂癌的手术方法及其临床效果。方法:实施肾盂癌根治术联合经尿道电切手术22例(男13例,女9例;年龄46～80岁),随访5～56个月,平均31.3个月。首先结扎输尿管下段,插入输尿管导管,行肾癌根治术、中上段输尿管切除,从输尿管断端向膀胱插入输尿管导管,并在输尿管断端缝一针丝线穿过输尿管导管并结扎固定,换截石位,经尿道将输尿管套入膀胱后,电切镜切除输尿管壁内段及袖口状切除周围1cm膀胱壁,止血后保留尿管。结果:22例手术均获一次成功,平均手术时间105min,平均出血量110mL,无并发症,平均随访31.3个月,5例复发膀胱肿瘤(占22.7%),无肾窝及远处转移。结论:肾盂癌根治术联合经尿道电切治疗肾盂癌是一种安全、简单、根本有效的手术方法,值得推广。

Objective： To assess the methods and results of nephroureterectomy combined with transurethral resection of the intramural ureter and bladder cuff. Methods： Nephroureterectomy combined with transurethral resection of the intramural ureter bladder cuff was carried out on 22 cases （13 males and 9 females, aged from 46 to 80 years） of renal pelvic carcinoma and the patients were followed up for 5 to 56 months with a mean time of 31.3 months. The lower part of the ureter was ligated first. Standard nephrectomy was performed after placement of a ureteral catheter. The lumbar ureter was resected and the catheter tip tied to the top of the distal portion of the ureter, which was later intussuscepted when the catheter was removed. Change to lithotomy position, transurethral resection through the muscular wall and into the perivesical fat was performed around the everted ureteral orifice, and the bladder spontaneously close to an indwelling Foley catheter. Results： All of the patients were successfully treated. The mean duration of surgery was 170 minutes, and the mean blood loss was 150 mL with no complications. During the mean follow-up of 31.3 months, 5 patients （22.7%） experienced recurrence of bladder tumors, but no renal fossa recurrence, and no distant metastases. Conclusion： This study confirms that nephroureterectomy combined with transurethral resection of the intramural ureter and bladder cuff is a safe, simple, radical and valid procedure and is worth being applied more extensively.