完全腹腔镜下根治性肾及输尿管全长切除术的临床应用

Clinical application of total transperitoneal laparoscopic radical nephroureterectomy

目的：回顾性分析经腹腔途径完全腹腔镜下肾、输尿管全长切除术的安全性及有效性。方法回顾性分析2011年9月至2014年12月采用经腹腔镜途径完全腹腔镜下肾、输尿管全长切除术治疗的11例患者的临床资料，肿瘤位于左侧6例，右侧5例；其中肾盂肿瘤6例，输尿管肿瘤4例，肾盂、输尿管多发肿瘤1例；肿瘤长径（2.50±0.65）cm。结果11例均在腹腔镜下完成手术，无开放病例。手术时间（143.00±11.88）min，术中估计失血量（85.00±23.39）ml，术后（2.60±0.67）d肛门排气，术后（2.20±0.40）d下床活动，无输血病例及严重并发症发生。术后11例均诊断为尿路上皮癌。术后随访12~24个月，1例复发膀胱肿瘤，其余无肿瘤复发及穿刺通道转移。结论经腹腔途径腹腔镜下肾输尿管全长切除术具有创伤小、出血少、恢复快的优点，是治疗上尿路肿瘤安全有效的方法之一。

Objective To analyze the efficacy and safety of total transperitoneal laparoscopic radical nephroureterectomy for renal pelvic and ureteral carcinoma. Methods The clinical data of 11 ca-ses underwent total transperitoneal laparoscopic radical nephroureterectomy from September 2011 to De-cember 2014 were collected. Neoplasmas were located at renal pelvis in six cases,at ureter in four cases, at both renal pelvis and uretel in one case;Six cases in right,five cases in left. The average neoplasma diameter was（2. 50 ± 0. 65）cm. Results All cases were successfully performed by total transperitoneal approach. The operation time was（143. 00 ± 11. 88）minutes,estimated average blood loss was（85. 00 ± 23. 39）ml,the exhaust time was（2. 60 ± 0. 67）days postopratively,the time to ambulation was（2. 20 ± 0. 40）days after operation. No serious complications or blood transfusion occurred. All patients were path-ologically diagnosed urinary tract epithelial carcinoma. The patients were followed-up for 12-24 months,＆amp;nbsp;one patient had bladder tumor recurrence and underwent transurethral resection of the tumor,the others had no local carcinoma recurrence and port site metastasis. Conclusions Total transperitoneal laparoscopic radical nephroureterectomy has advantages of less trauma,less blood loss,rapid recovery. It is a safe and effective method for the treatment of renal pelvic and ureteral carcinoma.