摘要
目的:介绍后腹腔镜肾输尿管切除术结合经腹腔下腹正中切口治疗移植肾同侧原上尿路移行细胞癌的最初经验。方法:选取2005年11月至2009年1月间,北京大学第三医院15例肾移植后因移植肾同侧原上尿路移行细胞癌而接受结合经腹腔下腹正中切口的后腹腔镜肾输尿管切除术的患者。后腹腔镜下将肾切除后,经膀胱镜行同侧输尿管口及膀胱袖状切除术,于下腹正中做6～8 cm切口,经腹腔途径将远端输尿管切至膀胱壁内段后,将输尿管完整取出,并经此切口完整取出标本。结果:平均手术时间为253 min,平均术中出血245 mL,3例患者接受输血治疗。后腹腔镜肾切除术中无1例中转开放,2例患者出现轻微并发症。病理结果显示:3例肾盂、1例肾盂和输尿管、3例肾盂和膀胱、1例双侧肾盂、4例输尿管、2例输尿管和膀胱和1例双侧输尿管内可见移行细胞癌。平均随访35个月,无1例患者后腹腔内复发或远处转移。5例并发膀胱癌患者中在随访时发现有2例复发膀胱癌,4例行单侧肾输尿管切除的患者在随访中发现对侧原上尿路移行细胞癌。结论:后腹腔镜肾输尿管切除术结合下腹正中经腹腔切口的方法可能是一个治疗移植肾同侧原上尿路移行细胞癌的安全且有效的选择。
Objective：To present the preliminary experience of the operative procedure and clinical outcomes of retroperitoneal laparoscopic nephroureterectomy （RPLNU） with a midline lower abdominal transperitoneal incision for native upper urinary tract transitional cell carcinoma （UUT-TCC） ipsilateral to a transplanted kidney. Methods： In the study, 15 renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated on with RPLNU via a midline lower abdominal transperitoneal incision between November 2005 and January 2009. Retroperitoneal laparoscopic nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6 - 8 cm midline lower abdominal incision was made. The distal ureter was dissected transperitoneally into the intramural segment and extracted completely. The intact specimen was removed manually via the same incision. The cystostomy was generally sutured. Results： The mean operation time was 253 minutes. The mean estimated blood loss was 245 mL. Three patients needed blood transfusion. No open conversion was required during the retroperitoneoseopic nephrectomy. Two of the patients suffered from minor complications. The pathological findings confirmed UUT-TCC in all the patients with 9 of the pelvises and 9 of the ureters. Five of the patients were involved with bladder TCC. With the mean follow-up of 35 months, none of them had retroperitoneal recurrence or distant metastasis, 2 of the 5 patients with bladder TCC had recurrence in bladder and 4 had contralateral native UUT-TCC after the first unilateral nephroureterectomy. Conclusion： RPLNU with a midline lower abdominal transperitoneal incision may be a safe and feasible alternative for native UUT-TCC ipsilateral to a transplanted kidney with satisfactory oncologic outcomes.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2012年第4期639-642,共4页
Journal of Peking University:Health Sciences
关键词
癌
移行细胞
尿道
腹腔镜检查
肾切除术
肾移植
Carcinoma, transitional cell
Urethra
Laparoscopy
Nephrectomy
Kidney transplantation
