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目的:探讨后腹腔镜联合下腹部斜切口治疗输尿管癌的手术方法及其临床效果。方法:本组患者均采用气管插管麻醉。首先,采用下腹部斜切口将输尿管下段和膀胱壁段输尿管及膀胱内输尿管开口周围1cm的膀胱全层切除(膀胱袖口状切除),再将患者改为健侧卧位(同肾切除术体位),在腹腔镜下行患肾切除术。将切除之肾脏放入标本袋,拆除下腹切口的缝线,自原下腹斜切口将患肾取出。结果:手术时间为150～180min,平均为140min;术中出血量为10～60ml,平均为20ml。肠道恢复时间为术后1～3天,平均为1.5天。术后2～4天开始进食。手术后7～10天痊愈出院。手术后病理报告:12例均为输尿管移行细胞癌Ⅰ～Ⅱ级,侵及固有膜。术中和术后均未发生并发症。术后随访1～19个月,一般状况均良好,无肿瘤复发及转移。结论:后腹腔镜手术联合下腹斜切口治疗输尿管癌,具有创伤小、解剖清晰、术中出血少、术后恢复快等优点,是一种安全、有效的治疗方法。
Objective: To investigate the surgical methods and clinical effects of retroperitoneal laparoscopic combined with lower abdominal oblique incision in the treatment of ureteral carcinoma. Methods: The patients were tracheal intubation anesthesia. First, the lower abdominal oblique incision of the lower ureter and bladder wall ureter and bladder ureter around the opening 1cm of the bladder resection (bladder cuff resection), then the patient to the healthy lateral position (with nephrectomy position) , Underwent laparoscopic nephrectomy. The excised kidney into the specimen bag, remove the lower abdominal incision suture, remove the affected kidney from the original abdominal incision. Results: The operation time was 150 ~ 180min with an average of 140min. The blood loss was 10 ~ 60ml with an average of 20ml. Intestinal recovery time after 1 to 3 days, an average of 1.5 days. After 2 to 4 days to start eating. 7 to 10 days after surgery cured. Postoperative pathology report: 12 cases of ureteric transitional cell carcinoma Ⅰ ~ Ⅱ grade, invasion and lamina propria. No intraoperative and postoperative complications occurred. Follow-up 1 to 19 months after surgery, the general condition are good, no tumor recurrence and metastasis. Conclusions: Retroperitoneal laparoscopic surgery combined with lower abdominal oblique incision in the treatment of ureteral carcinoma has the advantages of less trauma, clear anatomy, less intraoperative bleeding and faster recovery after operation. It is a safe and effective treatment.