手助腹腔镜在上尿路移行细胞癌治疗中的应用

The use of hand-assisted laparoscopic surgery in the treatment of upper urinary tract transitional cell carcinoma

目的 :探讨手助腹腔镜在肾输尿管全长切除术加膀胱袖套状切除术中的应用价值。方法 :采用手助腹腔镜行肾输尿管全长切除术 ,加膀胱袖套状切除术治疗上尿路移行细胞肿瘤 7例 (其中经腹腔途径 5例 ,经腹膜后途径 2例 )。病理类型均为移行细胞癌 (肾盂移行细胞癌 5例 ,输尿管移行细胞癌 1例 ,肾盂和输尿管多发性移行细胞癌 1例 )。结果 :7例手助腹腔镜手术均获成功。手术时间 5 0～ 15 0min ,平均 97.5min ;术中出血 5 0～30 0ml,平均 111.4ml;术后住院时间 7～ 5 3d。结论 :采用手助腹腔镜行肾输尿管全长切除术加膀胱袖套状切除术治疗上尿路移行细胞癌 ,是一种可选择的新的手术方式 ,与开放手术相比 ,具有损伤小、出血少、术后恢复快等优点。

Objective:To evaluate the role of hand-assisted laparoscopic nephroureterectomy and bladder cuff excision in the treatment of upper urinary tract transitional cell carcinoma.Method:Hand-assisted laparoscopic nephroureterectomy and bladder cuff excision was performed on 7 patients(5 cases underwent transperitoneal approach and 2 cases underwent retroperitoneal approach). Patients ranged in age from 47 to 80 years(average 67.9). The final pathologic examination revealed upper urinary tract transitional cell carcinoma(TCC) in 7(TCC of renal pelvis in 5; TCC of ureter in 1; multiple TCC of renal pelvis and ureter in 1).Result:Hand-assisted laparoscopic nephroureterectomy and bladder cuff excision was performed successfully on 7 patients. The mean surgical time was 97.5 min (ranged 50～150 min), and the mean estimated blood loss was 111.4 ml (ranged 50～300 ml). The postoperative hospital stay was 7～53 days.Conclusion:The results showed that hand-assisted laparoscopic nephroureterectomy and bladder cuff excision is an efficacious, minimally invasive alternative surgical technique for upper urinary tract transitional cell carcinomas, as it provides less blood loss, faster recovery compared with open surgery.