论文部分内容阅读
目的:探讨后腹腔镜下肾输尿管全长切除加经尿道膀胱袖状切除术治疗上尿路上皮癌的临床效果。方法:上尿路上皮癌患者68例,男23例,女45例,平均年龄63(43～78)岁。肾盂癌55例,输尿管上段肿瘤4例,输尿管下段肿瘤9例。其中输尿管下段肿瘤合并膀胱肿瘤1例。经尿道膀胱镜患侧输尿管逆行插入输尿管导管引流肾盂尿,用电切镜针状电极距输尿管口周围约0.5cm环形切透膀胱壁,分离出输尿管开口及膀胱壁内段。拔除输尿管导管,电凝输尿管开口,使开口封闭,减少肿瘤细胞种植机会。采用腰部3个穿刺套管针入路,行后腹腔镜下根治性肾切除,输尿管尽量向下游离,如果是肾盂癌或输尿管上段肿瘤,用腹腔镜分离钳可以将下段输尿管提拉出来,扩大套管切口,将肾输尿管全长完整取出,避免了下腹部开放切口;如果是下段输尿管肿瘤,则需下腹部行5～7cm切口,先取出肾标本,再行输尿管下段切除术。结果:68例手术顺利。手术时间平均120(90～240)min,术中出血量平均60(40～500)ml,1例需输血。术后引流管留置时间平均4(3～7)d,导尿管留置时间平均8(7～15)d,拔除尿管后均行B超检查无膀胱漏尿。术后病理报告均为尿路上皮癌。65例患者获随访平均18(3～38)个月。58例患者无瘤生存,3例死于心脑血管及肺部疾病。4例术后患膀胱肿瘤而行电切治疗。结论:后腹腔镜下肾输尿管全长切除加经尿道膀胱袖状切除治疗上尿路上皮癌,手术安全易行,用电切镜环状切除输尿管开口及膀胱壁内段可完整切除输尿管,对输尿管开口进行电凝封闭可减少肿瘤细胞种植。对肾盂癌及上段输尿管肿瘤患者可避免行下腹部开放切口的输尿管下段切除术,有效减少创伤,疗效可靠,无肿瘤种植转移。
Objective: To investigate the clinical effect of retroperitoneal laparoscopic radical nephroureterectomy and transurethral resection of the bladder on upper urothelial carcinoma. Methods: 68 cases of upper urothelial carcinoma, 23 males and 45 females, average age 63 (43 ~ 78) years old. 55 cases of renal pelvic cancer, upper ureteral tumors in 4 cases, lower ureteral tumors in 9 cases. One case of lower ureteral tumor with bladder tumor. Transurethral ureter ipsilateral ureteral retrograde insertion of ureteral catheter drainage of pelvic urinary, with resection needle-shaped electrode around the ureter orifice about 0.5cm circular incision through the bladder wall, ureter opening and the separation of the inner wall of the bladder. Removal of the ureteral catheter, electrocoagulation of ureteral openings, the opening is closed, reducing tumor cell planting opportunities. The use of three puncture trocar waist approach laparoscopic radical nephrectomy, the ureter as far downward as possible, if it is renal pelvis cancer or upper ureteral tumor with laparoscopic separation forceps can pull the lower ureter out to expand Casing incision, the complete removal of the full length of the renal ureter, to avoid the lower abdomen open incision; if the lower ureter tumor, you need to lower abdominal line 5 ~ 7cm incision, remove the kidney specimens, and then under the ureter resection. Results: 68 cases were successful. The average operation time was 120 (90 ~ 240) min. The mean intraoperative blood loss was 60 (40 ~ 500) ml. One patient needed blood transfusion. Postoperative drainage tube indwelling time averaging 4 (3 ~ 7) d, urinary catheter retention time averaging 8 (7 ~ 15) d, after removal of the catheter B ultrasound examination without bladder leakage. Postoperative pathological reports are urothelial carcinoma. 65 patients were followed up for an average of 18 (3 to 38) months. 58 patients survived without tumor and 3 patients died of cardiovascular and pulmonary diseases. 4 cases of bladder cancer patients underwent electrical resection. Conclusions: Retroperitoneal laparoscopic radical nephroureterectomy combined with transurethral resection of bladder sleeve for the treatment of upper urothelial carcinoma is safe and easy to operate. Laparoscopic resection of the ureteral orifice and the inner wall of the bladder wall can completely remove the ureter. Ureteral opening for electrocoagulation can reduce tumor cell growth. On the renal pelvis and upper ureteral tumors in patients with lower abdominal open incision to avoid the lower ureter resection, reduce trauma, reliable, no tumor metastasis.