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目的探讨后腹腔镜联合经尿道电切镜治疗上尿路移行细胞癌的效果和安全性。方法2003年3月～2006年7月,我院采用后腹腔镜联合经尿道电切镜治疗83例上尿路移行细胞癌。经尿道袖状电切患侧输尿管口周围1.5cm范围膀胱壁达膀胱外脂肪组织,采用后腹腔镜切除肾及全长输尿管。术后留置导尿管7d。11例术后辅助放疗。结果83例手术均成功。手术时间115～205min,平均156min。术中出血50～150ml,平均80ml。无术中并发症。术后住院7～11d,平均8.5d。病理报告:82例上尿路移行细胞癌,1例肾盂上皮中～重度不典型增生。术后随访3～38个月,平均10.8月。术后12个月内行膀胱镜检查发现膀胱肿瘤6例,其中5例行经尿道膀胱肿瘤电切,1例行腹腔镜根治性膀胱全切术、左侧输尿管皮肤造口术。2例肾盂肿瘤(pT3G3和pT2G3)于术后3个月肝转移。2例输尿管中段肿瘤(pT3G3和pT3G2～3)术后6个月原位复发并肺转移。1例输尿管下段肿瘤(pT3G3)术后6个月骨转移。失访1例。其余71例均未发现肿瘤复发、切口转移及远处转移。结论对于上尿路移行细胞癌,采用后腹腔镜联合经尿道电切镜行肾、输尿管全切及膀胱袖套状切除具有创伤小、安全、恢复快等优点,值得临床推广应用。
Objective To investigate the effect and safety of retroperitoneal laparoscopy combined with transurethral resection microscopy in the treatment of upper urinary tract transitional cell carcinoma. Methods From March 2003 to July 2006, 83 cases of transitional cell carcinoma of the upper urinary tract were treated with retroperitoneal laparoscopy and transurethral resection in our hospital. Transurethral resection of the cuff ipsilateral ureteral orifice around the bladder wall up to 1.5cm bladder fat tissue, the use of retroperitoneal laparoscopic resection of the kidney and full-length ureter. Postoperative catheter 7d. Eleven patients received adjuvant radiotherapy. Results 83 cases were successful. Operation time 115 ~ 205min, an average of 156min. Intraoperative bleeding 50 ~ 150ml, an average of 80ml. No intraoperative complications. After hospitalization 7 ~ 11d, an average of 8.5d. Pathological reports: 82 cases of upper urinary tract transitional cell carcinoma, 1 case of renal pelvic epithelial ~ severe atypical hyperplasia. The patients were followed up for 3 to 38 months with an average of 10.8 months. In 12 months after operation, bladder tumor was found in 6 cases by cystoscopy, of which 5 cases underwent transurethral resection of the bladder tumor, 1 case underwent laparoscopic radical mastectomy and left ureterocutaneous ostomy. Two cases of renal pelvis tumors (pT3G3 and pT2G3) had liver metastases at 3 months after operation. Two cases of middle ureteral tumors (pT3G3 and pT3G2 ~ 3) recurred in situ and lung metastases 6 months after surgery. One case of lower ureteral tumor (pT3G3) had bone metastases at 6 months after operation. Lost in 1 case. The remaining 71 patients did not find tumor recurrence, incision metastasis and distant metastasis. Conclusion For upper urinary tract transitional cell carcinoma, retroperitoneal laparoscopy combined with transurethral resection of the kidney, ureter and cuff resection has the advantages of small trauma, safety and quick recovery, which is worthy of clinical application.