经尿道电切联合后腹腔镜在上尿路肿瘤手术中的应用体会

The use of transurethral plasma electrocision combined with retroperitoneal laparoscopy in the treatment of upper urinary tract transitional carcinoma

目的:探讨应用经尿道等离子电切镜联合后腹腔镜行膀胱输尿管口袖套状切除加肾输尿管全长切除术治疗上尿路移行细胞癌的可行性及安全性。方法:选取12例上尿路移行细胞癌患者,首先取截石位,应用经尿道等离子电切镜行膀胱输尿管口袖套状切除术,再改为健侧卧位采用后腹腔镜行肾输尿管切除,术中游离出输尿管中上段,最后采取麦氏点或反麦氏点切口游离输尿管下段并取出标本。术后常规行膀胱灌注化疗。结果:手术均获成功,手术时间平均(155.3±13.3)min,出血量平均(81.3±20.8)ml,术后平均(9.1±0.9)d出院,无严重并发症发生。术后随访1.5年,1例发生膀胱移行细胞癌。结论:经尿道等离子电切镜联合后腹腔镜手术治疗肾盂输尿管上尿路移行细胞癌安全、可行,具有术后康复快、手术创伤小及并发症少等优点,具有良好的应用前景。

Objective： To investigate the feasibility and safety of sleeve excision of bladder at ureteral orifice and total nephroureterectomy under transurethral plasma electrocision and retroperitoneal laparoscopy for upper urinary tract transitional carcinoma. Methods ：Twelve cases with upper urinary tract transitional carcinoma were performed bladder sleeve excision at ureteral orifice by transurethral plasma electrocision using lithotomy position at first, and then retroperitoneal laparoscopic radical nephroureterectomy in uninjured side-lying ~ition. Middle-upper segment of ureter was separated. At last lower ureter was freed and entire specimens were removed through McBurney incision or antl-McBurney recision. Routine bladder irrlgatoon was performed in all patients. Results：All op- erations were performed successfully. The operative time was （ 155.3 ±13.3 ） min, the estimated blood loss was （ 81.3± 20.8 ） ml, and the duration of postoperative hospitalization was （9.1 ±0.9） d. There were no serious complications. Only 1 case was found suffering from bladder transitional carcinoma during 1.5 years follow-up. Conclusions ： Transurethral plasma electrocision combined with retroper- itoneal laparoscopy for upper urinary tract transitional carcinoma is a safe and effective procedure with rapid recovery, minimal invasion, few complications and promising prospect.