摘要
目的探讨经尿道双极等离子体电切镜行输尿管下段切除在肾盂输尿管癌根治中的应用价值。方法2003年6月～2005年3月，6例输尿管下段、同侧输尿管口及膀胱均未见肿瘤的肾盂输尿管癌，采用经尿道等离子电切镜联合腰部切口5例，后腹膜腹腔镜1例行肾输尿管全切术。结果6例手术顺利。手术时间120—210min，平均150min。术中尢一例发生闭孔神经反射。术后膀胱冲洗，未见出血。留置尿管7～9d。平均8d。1例术后5d拔尿管后出现患侧下腹疼痛、发热，证实少许尿外渗，再次留置尿管5d后，经尿道膀胱造影无渗漏，排尿恢复正常。术后病理结果输尿管残端均阴性。除1例术后3个月死于心肌梗死外，余5例术后随访7～21个月，平均16个月，未见肿瘤复发。结论输尿管下段切除术中应用经尿道双极等离子电切镜微创、无出血、并发症少，是辅助肾盂输尿管癌根治术中行之有效的方法。
Objective To study the application of transurethral bipolar plasma kinetic vaporization of the distal ureterectomy in radical nephroureterectomy for renal pelvic or ureteral carcinoma. Methods A total of 6 patients with renal pelvic or ureteral carcinoma without involvement in ipsilateral distal ureter, ureteral office, and the bladder were included. Radical nephrouretereetomy was performed by using transurethral bipolar plasma kinetic vaporization combined with either flank incision nephrectomy （5 patients） or retroperitoneal approach laparoscopic nephreetomy （ 1 patient）, Results The operation was completed smoothly in the 6 patients with comparatively little blood loss. The operation time was 120 - 210 rain （mean, 150 min）. Obturator nerve reflex happened in no patients during the operation. Postoperative bladder irrigation found no bleeding in the bladder. The time of indwelling the catheter was 7 -9 d （mean, 8 d）. Hypogastralgia and fever occurred in 1 patient on the 5th postoperative day. And the patient was confirmed as having mild urinary extravasation and was given catheter indwelling for 5 days. Transuretheral eystography found no leakage and a full recovery of voiding function was achieved. Postoperative pathological findings showed negative margins in all the patients. One patient died of myocardial infarction 3 months after operation, while follow - up in the remaining 5 patients for 7 - 21 months （mean, 16 months） showed no tumor recurrence, Conclusions Application of transurethral bipolar plasma kinetic vaporization of the distal ureterectomy is micro - invasive, with little hemorrhage and few complications. It is an effective assistant option in radical nephroureterectomy.
出处
《中国微创外科杂志》
CSCD
2006年第3期197-198,共2页
Chinese Journal of Minimally Invasive Surgery
