摘要
目的:探讨经尿道膀胱输尿管口袖状电切联合后腹腔镜肾、输尿管全段切除治疗上尿路移行细胞癌的优势和技术要点。方法:13例上尿路移行细胞癌患者采用后腹腔镜行肾、输尿管全段切除联合膀胱输尿管口袖状电切,男4例,女9例,年龄52～78岁,平均62.3岁,肾盂癌7例,左侧3例,右侧4例,输尿管癌6例,左侧5例,右侧1例。同时伴发膀胱癌2例。手术气管插管全麻下经尿道距输尿管口约1cm环形切透膀胱,电凝止血,不做膀胱冲洗。应用腹腔镜(0°或30°),建立后腹腔间隙,行根治性肾切除及完全游离输尿管。结果:13例手术均获一次成功,术后无并发症,手术总时间150～330min,平均216min,经尿道输尿管口袖状电切时间20～50min,平均30min,出血约:50～600ml,平均135ml。术后常规行膀胱灌注,预防肿瘤复发;病理诊断均为上尿路移行细胞癌Ⅱ～Ⅲ级,病理分期为T1N0M0或T2N0M0;随访2～30个月,平均15个月。1例术后出现原发部位以外的膀胱癌复发,余患者无穿刺点、切口及后腹膜腔种植、复发。结论:经尿道膀胱输尿管口袖状电切联合后腹腔镜肾输尿管全切治疗上尿路移行细胞癌创伤小、恢复快,并发症少,切除完整等优势,不增加肿瘤种植的风险,取得满意的无瘤生存率和肿瘤特异生存率。
Objective： To study the advantages and specific techniques of retroperitoneal laparoscopy and transurethral resectoscope in total nephroureterectomy with bladder cuff excision for upper urinary tract transitional cell carcinoma. Methods： A total of 13 patients （4 males and 9 females, aged from 52 to 78 years） with transitional cell carcinoma underwent radical nephroureterectomy and bladder cuff excision with retroperitoneal laparoscopy and transurethral resectoscope between January 2006 and January 2008. Of the 13 cases, 7 had renal pelvic tumors （3 cases had tumor in the left kidney and 4 cases had tumor in the right kidney） and the other 6 cases had ureteral tumors （5 cases had tumor in the left ureter and 1 case had tumor in the right ureter）. Two cases had tumors in both the ureter and the bladder. An electrode was used to incise the bladder 1.0 cm away from the ureterostoma. Electric coagulation was used to effectively stop bleeding and the bladder was not irrigated. Then the operation was performed with a celioscope （30°or 0°）. CO2 was injected into the retroperitoneal space and the celioscope was put into the retroperitoneal space to dissect the kidney and dissociate the ureter completely. Results： All of the patients were successfully treated without complications. The total duration of surgery was 150-330 min, with an average time of 216 min. The duration of transurethral bladder cuff excision was 20-50 min, with an average time of 30 min. Blood loss was 50 to 600 ml. Postoperative vesicle irrigation was performed to prevent tumor recurrence. Postoperative pathology showed that the carcinoma was transitional cell carcinoma Ⅱ -Ⅲ, T1N0M0 or T2N0M0. During the follow up of 2-30 months, one patient had tumor recurrence in the bladder and the other patients had no tumor recur- rence, metastasis or implantation. Conclusion： Radical nephroureterectomy and bladder cuff excision by retroperitoneal laparoscopy and transurethral resectoscope are effective treatments for transitional cell carcinoma, with minimal invasiveness, quicker recovery, fewer complications, complete excision of the ureter, and satisfactory disease-free and disease specific survival rates.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2008年第22期1307-1309,共3页
Chinese Journal of Clinical Oncology
