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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 introduce the experience of retroperitoneal laparoscopic radical nephrectomy, total length of ureter and bladder sleeve resection. Methods Retroperitoneal laparoscopic nephroureterectomy and sleeve cystectomy were performed in 35 cases. There were 14 males and 21 females. Age 49 ~ 82 years old, average 67 years old. 20 cases of ureteral tumors, renal pelvis tumors in 15 cases. Tumors were located on the right side in 19 cases and on the left side in 16 cases. Among them, 2 cases of ureteral tumor with bladder tumor, bilateral ureteral tumor and 1 case of bladder tumor occurred successively. Transurethral needle electrodes from the ureteral orifice about 0.5cm loop through the bladder. The use of three puncture trocar approach the waist, radical radical nephrectomy, the ureter as far as possible away from the lower abdomen line 5 ~ 9cm incision, remove the kidney specimens, and then line the lower ureter and some bladder sleeve resection. Results 35 cases were operated smoothly, the operation time was 1.5 ~ 6.0 hours, with an average of 3.1 hours. Bleeding volume 20 ~ 1600ml, an average of 166ml. 4 cases need blood transfusion. After 20 ~ 32h out of bed activity. Postoperative pathology was reported in 30 cases of transitional cell carcinoma, 2 cases of ureteral poorly differentiated adenocarcinoma, 1 case of ureteral squamous cell carcinoma, 1 case of ureteral leiomyosarcoma and 1 case of yellow granulomatous pyelonephritis. One patient underwent preoperative uremic dialysis with postoperative duodenal leakage. A drainage tube was placed on the third postoperative day to drain the duodenal leakage and died of heart failure two months after operation. After routine bladder perfusion to prevent tumor recurrence. The average length of stay 11d. The patients were followed up for 1 to 32 months with an average of 14 months. 33 patients survived without tumor and 1 patient had pelvic metastasis 3 months after operation. No recurrence of bladder cancer. Conclusion Laparoscopic surgery for the treatment of renal pelvis and ureter tumors, incision was significantly less than open surgery, postoperative recovery fast. With resectoscope ring resection of the ureter end can be completely removed the ureter.