经腹腔路径完全腹腔镜下移植肾同侧原肾输尿管全长切除术2例报告(附视频)

Sealed transperitoneal laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma ipsilateral to renal allograft(video)

目的探讨经腹腔路径完全腹腔镜下移植肾同侧原肾输尿管全长切除术治疗肾移植受者上尿路移行细胞癌的技术要点及临床效果。方法 2例肾移植术后移植肾同侧上尿路移行细胞癌患者,采用经腹腔路径完全腹腔镜下操作方法切除移植肾同侧原肾及输尿管全长。通过腹腔镜切除的原肾及输尿管最终从下腹正中小切口完整取出。结果两例手术时间分别为180,120 min,术中出血量分别为80,20 mL;无术中、术后并发症,术后血红蛋白及血清肌酐无明显变化。术后随访6个月均未出现肿瘤复发及转移。结论经腹腔路径完全腹腔镜下肾输尿管全长切除术治疗肾移植后移植肾同侧上尿路移行细胞癌具有手术损伤小、患者痛苦少、术后恢复快等优点,是一种安全有效的微创治疗方法。

Objective To discuss the surgical skills and clinical value of sealed transperitoneal laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma ipsilateral to renal allograft.Methods Two renal transplant recipients,who suffered from upper urinary tract transitional cell carcinoma ipsilateral to their renal allografts,underwent sealed transperitoneal laparoscopic nephroureterectomy.The involved kidneys and ureters were resected en bloc by means of laparoscopic techniques,and were removed through a short incision in the middle of the lower abdomen.Results Operations were successfully performed with 4-5 Trocars techniques.Operation time was 180 and 120 minutes for 2 patients,respectively.Blood lost during operations were 80 and 20 mL,respectively.No intraoperative and postoperative complication was observed.Renal function and hemoglobin of the patients remained stable.No tumor recurrence and metastasis was noted during a 6-month follow-up.Conclusion Sealed transperitoneal laparoscopic nephroureterectomy is a safe,effective method of treating upper urinary tract transitional cell carcinoma ipsilateral to renal allograft.