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目的探讨后腹腔镜手术联合经尿道电切治疗肾盂癌的手术方法及其临床效果。方法18例肾孟癌患者采用后腹腔镜联合经尿道电切,行肾输尿管全切加膀胱输尿管口袖套状切除。手术应用Olympus腹腔镜(30°或0°),气管插管全麻。切口位于腋中线与髂嵴上缘2 cm相交处,长10 mm。以自制水囊(充水250～300 ml)撑开腹膜后间隙,然后取出水囊,注入CO2气体,建立气腹,插入腹腔镜进行操作。术中电凝止血,不做膀胱冲洗。18例患者病理诊断均为肾盂移行细胞癌Ⅱ～Ⅲ级,病理分期为T1N0M0～T2N0M0。结果18例患者手术均获成功。手术时间150～190 min,平均160 min。住院时间7～10 d,术后无并发症。术后随访1～19个月,无肿瘤复发及转移,无切口肿瘤种植。结论后腹腔镜手术联合经尿道电切治疗肾盂癌具有创伤小,解剖清晰,术中出血少,术后恢复快等优点。
Objective To investigate the surgical methods and clinical effects of retroperitoneal laparoscopic surgery combined with transurethral resection of renal pelvis cancer. Methods 18 cases of renal cell carcinoma were treated with retroperitoneal laparoscopy combined with transurethral resection of the ureter and total nephroureterectomy combined with cuff ureter cuff resection. Olympus laparoscopic surgery (30 ° or 0 °), tracheal intubation general anesthesia. The incision is located at the midline of the axilla and the upper edge of the iliac crest 2 cm intersection, length 10 mm. To homemade balloon (filled with water 250 ~ 300 ml) propped up the retroperitoneal space, and then remove the balloon, CO2 gas injection, the establishment of pneumoperitoneum, laparoscopic operation. Intraoperative coagulation to stop bleeding, do not flush the bladder. 18 cases of pathological diagnosis of renal pelvis transitional cell carcinoma Ⅱ ~ Ⅲ grade, pathological stage T1N0M0 ~ T2N0M0. Results 18 patients were successful in surgery. The operation time was 150-190 minutes with an average of 160 minutes. Hospitalization time 7 ~ 10 d, no complications after surgery. All the patients were followed up for 1 to 19 months without tumor recurrence and metastasis, without incision tumor implantation. Conclusions Retroperitoneal laparoscopic surgery combined with transurethral resection of renal pelvic cancer has the advantages of less trauma, more clear anatomy, less intraoperative bleeding, and faster postoperative recovery.