肾移植术后一期后腹腔镜双侧原肾输尿管全长切除术

Simultaneous retroperitoneal laparoscopic bilateral nephroureterectomy for native kidneys in renal transplant recipients

目的:探讨肾移植术后一期行后腹腔镜下双侧原肾输尿管全长切除术(RPLBNU)的安全性和可行性。方法:对15例临床拟诊为原肾盂、输尿管尿路上皮癌(UC)的肾移植患者行RPLBNU。早期采用传统RPLB-NU治疗11例,近期4例实施改良RPLBNU。结果:15例行RPLBNU均成功,未中转开放。平均手术时间340.3min;平均出血量173.3ml,1例患者输悬浮红细胞400ml;术后平均使用吗啡当量20.7mg;术后平均下地活动时间4.1d;平均住院时间11.1d。所有患者均在术后第1天口服免疫抑制剂,并且无胃肠道相关并发症发生。改良RPLBNU更安全,患者术后恢复更快。除1例在术后27个月时发生左卵巢局部复发而放弃治疗失随访,平均随访46.0(17.0～73.5)个月,1例因膀胱肿瘤复发相继行膀胱肿瘤电切及膀胱部分切除治疗,仍存活。结论:肾移植术后RPLBNU,尤其是改良RPLBNU,是一种安全、可行的治疗方式,对移植肾功能无明显影响。

Objective：To evaluate the safety and feasibility of retroperitoneal laparoscopic bilateral nephroureterectomy（RPLBNU）for native kidneys in renal transplant recipients. Method.. Fifteen renal transplant recipients underwent simultaneous RPLBNU for clinically presumed native pelvic and ureteral urothelial carcinoma at our institute. 11 patients adopted customary technique,and 4 patients adopted novel technique. Result：All the procedures were completed successfully without open conversion. The mean operating room time was 340.3 minutes; the mean estimated blood loss was 173.3 ml,and one recipient need 400 ml blood transfusion; the mean morphine equivalents was 20.7 mg; the mean time to ambulation was 4.1 days,and mean hospital stay was 11.1 days. All recipients in our series resumed oral intake of the immunosuppressant on postoperative day 1, and there was no gastrointestinal complication. Novel technique was safer,and these 4 cases recovered quicker. Except for one recipient who developed local recurrence in left ovary and was lost from follow-up at the 27th month, until June 2012,with the mean follow-up of 46.0 （17.0--73.5） months. One recipient had recurrence in bladder treated by TUR-Bt and partial cystectomy, and was alive. Conclusion ： In our experience, RPLBNU, especially for native RPLBNU,is a technically feasible and safe alternative for native kidneys in RTx recipients,and didn＇t influence the renal function of transplanted kidney.