经尿道2μm激光联合后腹腔镜治疗上尿路肿瘤(附23例报告)

2μm laser via urethra combining with retroperitoneal laparoscopy in treatment of upper urinary tract urothelial tumors: a report of 23 cases

目的探讨后腹腔镜联合经尿道2μm激光治疗上尿路肿瘤的临床效果。方法对23例上尿路肿瘤患者行后腹腔镜肾、输尿管全段切除联合经尿道2μm激光膀胱输尿管口袖状切除,其中男13例、女10例,肾盂癌18例、输尿管癌5例。术后定期吡柔比星膀胱灌注化疗,并每3~6个月行经尿道膀胱镜检查、每6个月行CT尿路成像（CTU）检查,以观察肿瘤复发及转移情况。结果 23例手术均获成功,术后无严重并发症发生。手术用时164（135~225）min,术中出血72（40~150）ml。术后随访5~24个月,1例发现膀胱内新发肿瘤,余未见肿瘤复发、转移或腹腔种植。结论后腹腔镜联合经尿道2μm激光治疗上尿路肿瘤疗效肯定。

Objective To evaluate the clinical results of 2μm laser via urethra combining with retroperitoneal laparoscopy in treatment of upper urinary tract urothelial tumors.Methods Twenty-three cases（13 males and 10 females） with upper urinary tract urothelial tumours underwent retroperitoneal laparoscopic total nephroureterectomy and bladder cuff excision with 2μm continuous wave laser.Among 23 cases,18 had renal pelvic tumors and the other 5 had ureteral tumors.Postoperative intravesical chemotherapy with pirarubicin was given according to recommended dosage.After retroperitoneal laparoscopic total nephroureterectomy with bladder cuff excision for upper urinary tract urothelial tumours,cystoscopy was performed every 3 or 6 months,and computed tomography urography（CTU） was performed every half a year in order to observe tumor recurrence or metastasis.Results All the patients successfully underwent the operation without severe complication.Mean operation time was 164 min（ranged from 135 to 225min） and mean blood loss was 72ml（ranged from 40 to 150ml）.During the follow up of 5-24 months,the tumor recurrence in the bladder was found by cystoscopic examination in one patient.No tumor recurrence,metastasis or intra-abdominal implantation was found in other patients.Conclusion The method of retroperitoneal laparoscopic total nephroureterectomy with bladder cuff excision with the use of 2μm continuous wave laser for upper urinary tract urothelial tumors is feasible and effective,and has become an ideal surgical technique for upper urinary tract urothelial tumors.