摘要
目的介绍后腹腔镜下行肾、输尿管全长及膀胱袖状切除的体会。方法经后腹腔镜施行肾输尿管全长及袖状膀胱切除术35例。男14例,女21例。年龄49～82岁,平均67岁。输尿管肿瘤20例,肾盂肿瘤15例。肿瘤位于右侧19例,左侧16例。其中输尿管肿瘤合并膀胱肿瘤者2例,先后发生双侧输尿管肿瘤并膀胱肿瘤者1例。经尿道用针状电极距输尿管口约0.5cm环行切透膀胱。采用腰部3个穿刺套管针入路,行根治性肾切除,输尿管尽量向下游离,下腹部行5～9cm切口,取出肾标本,然后行下段输尿管及部分膀胱袖状切除。结果35例手术顺利,手术时间1.5～6.0h,平均3.1h。出血量20～1600ml,平均166ml。4例需输血。术后20～32h下床活动。术后病理报告为移行细胞癌30例,输尿管低分化腺癌2例,输尿管鳞状细胞癌1例,输尿管平滑肌肉瘤1例,黄色肉芽肿性肾盂肾炎1例。1例术前为尿毒症透析患者,术后并发十二指肠漏,术后第3天放置引流管引流十二指肠漏出液,术后2个月死于心力衰竭。术后常规行膀胱灌注,预防肿瘤复发。平均住院时间11d。随访1～32个月,平均14个月,33例患者无瘤生存,1例术后3个月发生盆腔转移,目前带瘤存活。膀胱肿瘤均未见复发。结论经后腹腔镜手术治疗肾盂和输尿管肿瘤,切口明显小于开放手术,术后恢复快。用电切镜环状切除输尿管末端可完整切除输尿管。
Objective To report our experience with retroperitoneoscopic nephroureterectomy with excision of a bladder-cuff for renal pelvic and ureteral tumors. Methods Thirty-five patients （21 women and 14 men;mean age,67 years ;age range,49- 82 years） with upper urinary tract tumors underwent retroperitoneal laparoscopic nephroureterectomy with excision of a bladder-cuff. Of the 35 cases, 15 had pelvic tumors and 20 had ureteral tumors; 19 cases had the tumors on the right side and 16 on the left. Two cases had ureteral tumors combined with bladder tumors. One case had bilateral ureteral tumors then concomitantly had bladder tumors. The needle electrode was used to circleround incise the bladder thoroughly 0.5 cm away from the ureterostoma. Three trocars in the waist were used for dissecting the kidney;and the ureter was dissected as far distally downward. Then an incision of 5 -9 cm was created in the lower abdomen to allow dissection of the distal ureter and bladder-cuff and intact specimen extraction. Results The operation was successful in all 35 patients. The mean operative time was 3.1 h（range, 1.5 -6.0 h）. The mean estimated blood loss was 166 ml （range,20 - 1600 ml）. Four cases received blood transfusion. The patient＇s activity recovered in 20 - 32 h after operation. Postoperative pathology showed transitional cell carcinoma in 30 cases, poorly differentiated adenocarcinoma in 2 （ureter） , squamous cell carcinoma in 1 （ureter） ,leiomyosarcoma in 1 （ureter） ,xanthogranulomatous pyelonephritis in 1. Duodenal leakage occurred in 1 patient who had had dialysis;a drainage catheter was placed on the third d after operation, and the patient died of heart failure after 2 months. Postoperative vesical irrigation was performed to prevent tumor recurrence. The mean hospital stay was 11 d. During a mean follow-up of 14 months （range, 1 -32 months） , 1 patient developed pelvic metastasis and was alive with the tumor. The other 33 patients survived free of tumor to date. No patient had recurrent transitional cell carcinoma of the bladder. Conclusions Our data demonstrate that retroperitoneoscopic nephroureterectomy for renal pelvic and ureteral tumors has shorter incision and more rapid postoperative recovery compared with open surgery. Using resectoscope to resect the termination of ureter allows more complete excision of the ureter.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2006年第7期450-452,共3页
Chinese Journal of Urology
关键词
肾盂
癌
腹腔镜
Kidney pelvis
Carcinoma
Laparoscopy
