后腹腔镜联合下腹部小切口治疗肾盂肿瘤

Retroperitoneal laparoscopy combined with little abdominal incision for treatment of renalpelvic carcinoma

目的评估腹腔镜联合腹部小切口术式治疗肾盂及输尿管肿瘤的可行性及优缺点,为腹腔镜临床技术的广泛开展提供更多的临床依据。方法 2006～2009年该院对14例术前临床分期评估为T1、T2期的患者进行了后腹腔镜联合腹部小切口治疗上尿路移形细胞肿瘤,患者年龄50～72岁,平均65.3岁。术中首先经后腹腔行肾脏切除;然后取下腹部小切口行患侧输尿管开口部分膀胱切除术。切除范围包括患肾、肾上腺、肾周脂肪组织、输尿管及部分膀胱,术中保持输尿管完整,最终通过下腹部切口取出切除患侧肾脏及输尿管。结果平均手术时间4h(3～4.5h),平均失血量200mL(75～300mL),患者平均住院时间8d(7～10d),无明显手术并发症。术后病检均为尿路移行细胞癌,病理分级G1级7例,G2级6例,G3级1例;临床分期均为T2N0M0。术后随访膀胱镜、B超,必要时CT及肾功能等,随访时间9～36个月,平均18个月,3名患者术后出现膀胱移形细胞肿瘤,其余患者随访暂未见异常。结论经后腹腔镜联合腹部小切口治疗上尿路肿瘤是一种临床疗效肯定的术式,相对于完全的开放手术,该术式具有创伤小及恢复快等优点。而相对于全腹腔镜下肾盂癌根治术,则易于掌握,故值得推广。

[Objective] To report our experience in the treatment of renalpelvic carcinoma with retroperitoneal laparoscopy combined with little abdominal incision.[Methods] An incision was made in lower abdomen for bladder resection and specimen extraction after excision of kidney by retroperitoneal laparoscopy.[Results] The operation was performed successfully in 14 patients without any complication.The operative time ranged from 3 to 4.5 h with a mean 4 h.The hospital stay after operation was 7 to 10 days.Three of the patients who got bladder tumor during follow-up months were carried out transurethral resection（TURBt）,and the rest of them were still followed up.[Conclusions] Our experience shows that retroperitoneal laparoscopy combined with little abdominal incision for renalpelvic carcinoma has less incision and rapider postoperative recovery compared with open surgery.And it also can be easily mastered by us,so the operation mode is worth popularizing.