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目的探讨肾移植患者泌尿系统恶性肿瘤的手术方式,以减少对移植肾的干扰。方法5例尿毒症患者肾移植后发生自体肾盂和输尿管恶性肿瘤,肿瘤均位于移植肾同侧,为避免开放性手术对移植肾的干扰,采用后腹腔镜联合膀胱电切镜行自体肾、输尿管及膀胱部分切除术,手术采用3个通路完成。结果5例手术经过顺利,手术耗时120～280min,术中出血量为50～200ml。术后12～36h恢复排气,尿量为1500～4000ml/d,血肌酐正常,不必调整免疫抑制方案,平均住院4.5d。结论采用后腹腔镜联合膀胱电切镜联合切除泌尿系肿瘤,具有安全、创伤小、术后恢复快等特点,尤其是对位于移植肾同侧的肿瘤,该术式对移植肾的干扰较小。
Objective To investigate the surgical treatment of urinary malignancies in renal transplant patients to reduce the interference of transplanted kidneys. Methods 5 cases of uremia patients after renal transplantation autologous renal pelvis and ureteral malignancies, tumors are located in the same side of the transplant kidney, in order to avoid the interference of open surgery on the graft, the use of retroperitoneal laparoscopic resection of the bladder with autologous kidney, ureter And partial resection of the bladder, surgery using three channels to complete. Results 5 cases of operation went well, the operation took 120 ~ 280min, intraoperative blood loss was 50 ~ 200ml. After 12 ~ 36h recovery of exhaust, urine output of 1500 ~ 4000ml / d, serum creatinine normal, do not need to adjust the immunosuppressive regimen, the average hospital stay 4.5d. Conclusions Combined retropericardoscopy and resection of the bladder combined with resection of urinary neoplasms has the characteristics of safety, less trauma and rapid recovery after operation. Especially for tumors located on the ipsilateral side of the transplanted kidney, the operation has less interference with the transplanted kidney .