后腹腔镜加下腹部小切口治疗肾盂癌23例分析

目的 评价后腹腔镜加下腹部小切口行肾盂癌根治术并总结经验.方法 回顾性分析2008年7月～2012年7月施行的23例后腹腔镜加下腹部小切口行肾盂癌根治术的临床资料.结果 手术均成功,无一例中转开放手术.平均手术时间(136.4±27.1) min,平均术中出血量(151.3±44.5) ml,平均术后肠功能恢复时间(1.8±0.3)d,术后引流管拔除时间2～5d,平均术后住院时间(7.2±1.0)d,术中术后未发生明显并发症.术后病理检查23例均为肾盂移行细胞癌,随访3～24个月,均未见肿瘤复发及转移.结论 后腹腔镜加下腹部小切口行肾盂癌根治术具有手术时间短,创伤小、恢复快、术后并发症少、并不增加肿瘤种植的风险等优点,值得临床推广.     

后腹腔镜加下腹部斜行小切口输尿管癌根治术

目的 评价后腹腔镜加下腹部斜行小切口输尿管癌根治性切除术治疗输尿管癌的手术疗效及并发症.方法 回顾性分析18 例行后腹腔镜加下腹部斜行小切口输尿管癌根治性切除术患者的临床资料,年龄43～81岁,平均59.5岁;左侧11例,右侧7例;下段10例,中段5例,上段3例;所有患者均行后腹腔镜加下腹部斜行小切口输尿管癌根治性切除术.结果 所有手术均取得成功,无一例中转为开放手术;平均手术时间为(120.2±33.3)min ,术中平均出血量(103±32.7)ml;术后肠功能恢复时间平均为(26±9)h ,术后平均住院时间为(10±1.3)d.围手术期未发生明显无并发症发生.16例术后得到1～40个月随诊,1例因其他疾病死亡,3例出现远处转移,2例膀胱内新发肿瘤,后行膀胱肿瘤电切术.结论 后腹腔镜加下腹部斜行小切口行输尿管癌根治术治疗输尿管癌是一种安全有效的微创方法,其具有手术时间短、出血少、恢复快、术后并发症少等优点.     

后腹腔镜加下腹小切口术治疗上尿路肿瘤(附18例报告)

目的探讨腹腔镜对肾盂或输尿管癌等上尿路肿瘤根治性切除术的手术方法,对加用下腹小切口术式的临床效果进行评价。方法回顾性分析18例行后腹腔镜加下腹部小切口肾盂癌或输尿管癌根治性切除术患者的临床资料及手术方法。结果手术均获成功,无一例中转开放;平均手术时间为120～176min,术中平均出血量110～200ml;术后肠功能恢复时间平均为26～48h,手术后30～48h下床活动;术后平均住院时间为6～8d。术中、术后未发生明显并发症。随访2～36个月均未见肿瘤复发及转移。结论后腹腔镜加下腹部小切口行肾盂癌和输尿管癌根治术是一种安全有效的微创方法,与传统开放手术和其他术式相比,具有手术时间短、出血少、恢复快、术后并发症少等优点。     

后腹腔镜联合下腹部小切口肾盂癌根治术的疗效观察

目的:探讨后腹腔镜联合下腹部小切口行根治性肾输尿管全切除术治疗肾盂癌的可行性及手术疗效。方法:回顾分析2009年11月至2014年7月为29例患者行后腹腔镜联合下腹部小切口技术肾盂癌根治术的临床资料。手术采用腰部三孔法切除患侧肾脏并尽量向膀胱侧游离输尿管,由下腹部5~7 cm小切口取出标本,直视下袖状切除输尿管膀胱壁内段,缝合膀胱切口。结果:29例手术均获成功,无中转开放手术。手术时间100~210 min,平均(150.0±43.5)min;术中出血量50~350 ml,平均(120.0±59.6)ml;术后住院8~12 d,平均(9.5±1.1)d。术后病理均提示尿路上皮癌。术后随访3~48个月,1例发生膀胱肿瘤,1例发生患侧腹膜后复发并双肺转移。结论:对于经验丰富且技术娴熟的外科医生,后腹腔镜联合下腹部小切口肾盂癌根治术是安全、有效的。     

经尿道钬激光、电切及开放手术处理膀胱袖套-输尿管下段的对照研究

目的 评估钬激光、电切及开放手术在上尿路上皮性恶性肿瘤根治术中袖套状切除膀胱-输尿管下段的临床疗效. 方法 回顾性分析2000年1月至2010年12月162例肾盂癌、中上段输尿管癌患者的资料.肾及近端输尿管切除术采用开放或后腹腔镜法.袖套状切除膀胱-输尿管下段分别采用钬激光(A组)32例、电切(B组)51例及开放手术(C组)79例.经尿道手术组术中插入5F输尿管气囊导管以阻断尿流.病理诊断均为肾盂和(或)输尿管上皮癌,病理分期为T(4)NoM0 ～T4N0M0.对3组围手术期指标(手术时间、术中失血量、术中并发症、术后住院时间等)和术后随访结果(肿瘤复发率、肿瘤种植发生率、患者生存率等)进行对照研究.术后随访3个月～8年. 结果 A、B组手术时间[(203.6±31.5),(207.2±24.3) min]、术中失血量[(127.4±63.2),(135.0±82.7) ml]、术后住院时间[(5.8±1.3),(5.6±1.2)d]显著低于C组[(248.0±42.9) min,( 484.5±217.7)ml,(8.7±3.5)d,P＜0.01].B组术中发生闭孔神经反射6例,膀胱穿孔合并较大出血3例,其中中转开放手术2例.3组术后膀胱肿瘤发生率(16.3％、18.1％、21.7％)、肿瘤种植发生率(均为0)、1、3年生存率(96.3％/90.5％、98.0％/88.6％、95.7％/86.4％)比较差异均无统计学意义(P＞0.05). 结论 经尿道术式的创伤程度、手术时间、术中失血量、术后恢复时间等围手术期指标显著优于传统开放手术,膀胱肿瘤发生率、肿瘤种植发生率、生存率等与开放手术相当.袖套状切除膀胱-输尿管下段的手术方式与术后肿瘤复发率无关.钬激光袖套状切除膀胱-输尿管下段是肾盂癌和输尿管癌根治术中安全、微创的方法.     

腹腔镜肾盂成形术联合输尿管软镜取石术治疗肾盂输尿管连接部梗阻合并肾脏结石临床研究

目的 观察腹腔镜肾盂成形术联合输尿管软镜取石术治疗肾盂输尿管连接部梗阻合并肾脏结石效果,并探讨其安全性.方法 选择本院于2013年1月至2014年12月收治的肾盂输尿管连接部梗阻合并肾脏结石患者72例作为研究对象,均符合手术指征,按照数字随机法分为两组,每组36例,对照组采取开放手术治疗,观察组采取腹腔镜肾盂成形术联合输尿管软镜取石术治疗,比较两组疗效.结果 观察组手术时间及术中出血量分别为(125.9 ±29.6)min、(124.7 ±45.2) mL,均显著低于对照组(187.9±35.6) min、(298.6 ±63.8)mL,差异具有统计学意义(P＜0.05).观察组住院时间、引流管拔除时间及术后胃肠道恢复时间均低于对照组,差异具有统计学意义(P＜0.05).观察组术后的并发症为7例(19.4％),与对照组8例(22.2％),差异无统计学意义(P＜0.05).结论 腹腔镜肾盂成形术联合输尿管软镜取石术治疗肾盂输尿管连接部梗阻合并肾脏结石效果较佳,创伤小,术后恢复快,具有重要临床价值.     

后腹腔镜加下腹部斜行小切口治疗上尿路尿路上皮癌的临床研究

目的：探讨后腹腔镜加下腹部斜行小切口行上尿路尿路上皮癌根治性切除术的方法,并对本手术方式的临床疗效及并发症进行评价。方法：回顾性分析18例后腹腔镜加下腹部斜行小切口上尿路尿路上皮癌根治性切除术患者的临床资料,并对其临床结果进行总结。结果：手术均获成功。平均手术时间为（120．8±24．5）min,术中出血量（63．3±19．7）ml;术后肠功能恢复时间平均为（26±10）h;术后平均住院时间为（7．0±2．3）天;术中及术后未发生明显并发症。随访2～30个月,均未见肿瘤复发及转移。结论：后腹腔镜联合下腹部斜行小切口肾盂、输尿管癌根治术是一种安全有效的微创治疗方法,与传统的开放手术相比,疗效相当,但同时具有手术时间短、创伤小、出血量少、恢复快、术后并发症少等优点,可作为。肾盂、输尿管尿路上皮癌的首选治疗方法。     

后腹腔镜肾输尿管全切加腹膜后肾周区域淋巴结清扫与开放手术治疗UUT-TCC疗效比较

目的:探讨后腹腔镜技术与开放手术治疗上尿路移行细胞癌(upper urinary tract transitional cell carcinoma,UUT-TCC)的效果及优势。方法:回顾性分析2009年11月~2012年12月间,我院采用后腹腔镜下肾输尿管根治性切除术加腹膜后肾周区域淋巴结清扫术治疗肾盂输尿管癌患者23例(腹腔镜组),并与同期14例行传统开放性肾输尿管切除术患者(开放术组)的手术时间、出血量、肿瘤学预后等指标进行比较。结果:腹腔镜组患者经术后病理检查,肾盂癌24例,输尿管癌10例,输尿管癌伴膀胱癌3例,其中腹腔镜组和开放组淋巴结转移各1例。同时研究发现:①腹腔镜组与开放术组比较,手术时间缩短,出血量明显减少,术后肠胃功能恢复快,术后住院时间短,差异有统计学意义(P0.05);②两种术式肿瘤学预后在远处转移方面,腹腔镜组更少,差异有统计学意义(P0.05)。结论:后腹腔镜下肾输尿管全长切除加经尿道膀胱袖状切除并腹膜后肾周区域淋巴结清扫治疗UUT-TCC具有创伤小、痛苦少、术后恢复快等优点,可能有更好的肿瘤学预后。     

腔静脉后输尿管三种手术方式的比较

目的：探讨腔静脉后输尿管的最佳治疗方式.方法：回顾性分析21例腔静脉后输尿管患者的治疗方法：14例行传统开放手术,其中1例行右肾切除术;3例行后腹腔镜下输尿管复位矫形术;4例行经腹腔手术,其中3例行腹腔镜下输尿管复位矫形术,1例行腹腔镜辅助下肾盂癌根治术.结果：21例手术均获成功.输尿管复位矫形术的开放组、后腹腔镜组和腹腔镜组平均手术时间分别为1.5 h、3.6 h和2.1 h;术中出血量分别为150m1、80 ml和70 ml;平均术后住院时间分别为7.5天、5天和6天.未出现围术期并发症.术后4～6周拔除双J管.随访6个月～4年,B超和（或）IVP复查无吻合口狭窄,输尿管梗阻均明显缓解.16例术前有右腰酸胀不适感症状者完全缓解.结论：采用腹腔镜下输尿管复位矫形术治疗腔静脉后输尿管应成为临床首选方式.经腹腹腔镜较后腹腔镜在腔静脉后输尿管段粘连严重的治疗和手术视野方面有一定优势.     

后腹腔镜联合下腹部小切口手术治疗上尿路上皮癌（附视频）

目的探讨微创手术治疗上尿路上皮癌的方法。方法回顾性分析2007年6月至2012年5月我院收治的上尿路上皮癌39例,男22例,女17例,年龄41-80岁,平均年龄（63±12）岁。其中左23例,右16例,肾盂癌31例,输尿管癌8例。结果39例患者均行后腹腔镜联合下腹部小切口半尿路根治性切除手术,手术时间105—150min,平均（115±12）min,术中出血50～600ml,平均（90±15）ml,1例术中输血400ml,无尿漏或严重腹腔镜手术相关并发症。术后住院8～14d,平均（9±2）d。术后病理均证实为尿路上皮癌,病理分期：T1N0M0 21例,T2N0M017例,T2N1M01例。术后随访2—32个月,平均（18±3）个月,其中肾盂癌患者局部复发1例,肝脏远处转移1例,输尿管癌患者膀胱种植转移行经尿道膀胱肿瘤电切术（TURBT）1例,肾盂癌患者因瘤死亡1例,其余35例患者无瘤生存至今。结论与传统开放手术相比,后腹腔镜联合下腹部小切口行肾、输尿管、膀胱袖状切除手术治疗上尿路上皮癌是一种可行、安全、有效、微创的方法。     

后腹腔镜联合经尿道输尿管口电切术治疗肾盂输尿管肿瘤(附17例报告)

目的:评估后腹腔镜联合经尿道输尿管口电切术治疗肾盂、输尿管肿瘤的临床疗效。方法:2008年10月至2013年1月为17例肾盂或输尿管移行细胞癌患者行后腹腔镜根治性肾输尿管切除术,其中肾盂癌11例,输尿管癌6例。经尿道袖状电切患侧输尿管口周围1 cm范围膀胱壁,采用后腹腔镜切除肾及全长输尿管,完整取出切除的肾输尿管。术后常规吡柔比星膀胱灌注。结果:手术时间平均(186.9±30.2)min;术中出血量平均(110.1±38.6)ml;术中、术后未发生明显并发症。术后随访3～51个月,1例发生膀胱移行细胞癌。结论:后腹腔镜联合经尿道电切镜治疗肾盂癌、输尿管癌具有手术损伤小、康复快等优点,且不增加肿瘤种植风险,临床应用前景良好。     

Laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma: the Cleveland Clinic experience

PURPOSE: We report our single institutional experience with retroperitoneal laparoscopic radical nephroureterectomy in patients with upper tract transitional cell carcinoma and compare results to those achieved by the open technique. MATERIALS AND METHODS: A total of 77 patients underwent radical nephroureterectomy for pathologically confirmed upper tract transitional cell carcinoma. Of these patients 42 underwent laparoscopic nephroureterectomy from September 1997 through January 2000 and 35 underwent open surgery. All specimens were extracted intact. Of the laparoscopic group the juxtavesical ureter and bladder cuff were excised by our novel transvesical needlescopic technique in 27 and radical nephrectomy was performed retroperitoneoscopically in all 42. Data were compared retrospectively with 35 patients undergoing open radical nephroureterectomy from February 1991 through December 1999. RESULTS: Laparoscopy was superior in regard to surgical time (3.7 versus 4.7 hours, p = 0.003), blood loss (242 versus 696 cc, p <0. 0001), specimen weight (559 versus 388 gm., p = 0.04), resumption of oral intake (1.6 versus 3.2 days, p = 0.0004), narcotic analgesia requirements (26 versus 228 mg., p <0.0001), hospital stay (2.3 versus 6.6 days, p <0.0001), normal activities (4.7 versus 8.2 weeks, p = 0.002) and convalescence (8 versus 14.1 weeks, p = 0.007). Complications occurred in 5 patients (12%) in the laparoscopic group, including open conversions in 2, and in 10 (29%) in the open group (p = 0.07). Followup was shorter in the laparoscopic group (11.1 versus 34.4 months, p <0.0001). The 2 groups were similar in regard to bladder recurrence (23% versus 37%, p = 0.42), local retroperitoneal or port site recurrence (0% versus 0%) and metastatic disease (8.6% versus 13%, p = 1.00). Mortality occurred in 2 patients (6%) in the laparoscopic group and 9 (30%) in the open group. Cancer specific survival (97% versus 87%) and crude survival (97% versus 94%) were similar between both groups (p = 0.59). CONCLUSIONS: In patients with upper tract transitional cell carcinoma who are candidates for radical nephroureterectomy the retroperitoneal laparoscopic approach satisfactorily duplicates established technical principles of traditional open oncological surgery, while significantly decreasing morbidity from this major procedure. Short-term oncological and survival data of the laparoscopic technique are comparable to open surgery. Although long-term followup data are not yet available, it appears that laparoscopic radical nephroureterectomy may supplant open surgery as the standard of care in patients with muscle invasive or high grade upper tract transitional cell carcinoma.     

后腹腔镜下与开放性肾癌根治术治疗局限性肾癌的比较

目的：评价后腹腔镜肾癌根治术治疗局限性肾癌的临床疗效。方法：局限性肾癌患者70例,其中行后腹腔镜下肾癌根治术（后腹腔镜组）30例,开放性。肾癌根治术（开放手术组）40例,2组患者年龄、性别、肿瘤分期大小差异无统计学意义,分析比较两组患者手术时间、术中出血量、住院时间、手术并发症及生存率的差异。结果：后腹腔镜组与开放手术相比：手术时间为90～360（110士11．3）min与l00～t50（100±10．5）min,差异有统计学意义（P〉O．05）,后腹腔镜组费时较长;术中出血50～1600（108．6±28．3）ml与70～1100（162．8±40．1）ml（P〈0．05）;术后需用镇痛剂8例与32例（尸〈0．05）、术后进食时间1～2（1．3±0．5）天与3～5（3．1±1．1）天（P〈O．05）、术后住院3～7（4．5士1．3）天与7～13（8．8±1．7）天（P〈O．05）,差异均有统计学意义。术后中位随访时间23个月（5～40个月）,生存率差异无统计学意义（P〉0．05）。结论：与开放肾癌根治术相比,后腹腔镜下肾癌根治术出血少、恢复快、术后并发症少,已成为局限性肾癌的首选治疗方法。     

后腹腔镜联合膀胱电切镜对上尿路移行细胞癌根治性治疗的安全性研究

目的探讨后腹腔镜联合膀胱电切镜对肾盂、中上段输尿管移行细胞癌根治性治疗的手术及肿瘤学安全性。方法回顾性分析肾盂、中上段输尿管移行细胞癌患者58例临床资料,后腹腔镜联合膀胱电切镜肾输尿管全长切除组（A组）41例,开放肾输尿管切除组（B组）17例。对其手术效果、并发症及术后肿瘤复发情况进行对比。结果A组和B组手术出血量（98．4和165mL）、术后住院天数（7．1和8．0d）、术后应用止痛药时间（1．2和3．1d）比较,A组优于B组（P〈0．05）;两组手术时间（150和110min）、术后留置尿管时间（6．2和3．5d）比较,A组长于B组（P〈0．05）。A组1例因电切输尿管口出血,中转开放手术。A、B两组并发症发生率（7．3％和11．8％）及肿瘤复发率（14．6％,23．5％）差异均无统计学意义（P均〉O．05）。结论联合尿道电切镜、后腹腔镜肾输尿管切除术与开放手术相比,出血少、术后恢复快、并发症少,未增加术后肿瘤的复发。     

Mayo Clinic Scottsdale Experience with laparoscopic nephroureterectomy.

OBJECTIVES: To evaluate the efficacy of laparoscopic nephroureterectomy for patients with transitional cell carcinoma of the upper urinary tract. METHODS: Eighteen patients underwent attempted transperitoneal laparoscopic nephroureterectomy between June 2000 and October 2002. Mean patient age was 67.5 years. The specimen was removed intact through a 7- to 9-cm extraction incision in the lower midline. In the majority of patients, the distal ureter was dissected through the extraction incision. RESULTS: Sixteen cases were completed laparoscopically. Two cases required conversion to an open procedure. In these cases, dense fibrosis was present around the renal hilum preventing further dissection. The mean operative time was 180 minutes, and the mean estimated blood loss was 160 mL. The mean length of stay was 3.3 days. Complications included the 2 conversions, and 1 patient with a postoperative Mallory Weiss tear. No port-site or distant metastasis occurred; however, 1 patient developed a retroperitoneal recurrence. CONCLUSION: Laparoscopic nephroureterectomy is an alternative to open nephroureterectomy. Cases with high-stage and grade may cause the laparoscopic dissection to be difficult. The extraction incision allows for easy dissection of the distal ureter.     

Radical nephrectomy and nephroureterectomy in the octogenarian and nonagenarian: comparison of laparoscopic and open approaches

Objectives. To retrospectively compare the outcome of laparoscopic and open radical nephrectomy or nephroureterectomy in patients 80 years old or older, inasmuch as the tolerance profile of major laparoscopic renal surgery in comparison to open surgery in the elderly patient has not been previously reported.Methods. Since September 1997, 11 patients 80 years old or older underwent retroperitoneal laparoscopic radical nephrectomy or nephroureterectomy for cancer. These patients were compared with 6 consecutive patients 80 years old or older who underwent comparable open surgery at our institution since January 1994. No tumor had computed tomographic evidence of lymphatic, vascular, or perirenal extension.Results. Baseline parameters were comparable between the laparoscopic and open groups. The laparoscopic group had a similar median surgical time (210 minutes versus 175 minutes; P = 0.1) and blood loss (150 mL versus 125 mL; P = 0.8) compared with the open group. However, specimen weight was larger in the laparoscopic group (568 g versus 292 g; P = 0.04). Moreover, the laparoscopic group had a quicker resumption of oral intake (less than 1 day versus 4 days; P <0.001), decreased narcotic requirements (14 mg versus 326 mg; P = 0.004), shorter hospital stay (2 days versus 6 days; P <0.001), and faster convalescence (14 days versus 42 days; P <0.001) compared with the open group.Conclusions. Retroperitoneal laparoscopic radical nephrectomy and nephroureterectomy are well tolerated by the elderly patient. Although our sample size was small, it appears that laparoscopy is an excellent alternative to open surgery for excision of selected renal malignancies in the octogenarian and nonagenarian population.     

Financial analysis of open versus laparoscopic radical nephrectomy and nephroureterectomy

PURPOSE: Laparoscopic radical nephrectomy and nephroureterectomy are rapidly becoming established procedures in select patients with renal cell carcinoma and upper tract transitional cell carcinoma, respectively. We present a retrospective comparative analysis of laparoscopic versus open radical nephrectomy and nephroureterectomy from a financial standpoint. The effect of the learning curve on costs incurred was also evaluated. MATERIALS AND METHODS: Detailed itemized cost data on 18 contemporary cases of open radical nephrectomy performed from September 1997 to July 1998 were compared with similar data on 20 initial laparoscopic cases performed from September 1997 to July 1998 and 15 more recent laparoscopic radical nephrectomy cases performed from August 1998 to July 1999. Financial data were also compared on 14 contemporary patients each who underwent open radical nephroureterectomy from June 1997 to December 1999, initial laparoscopic radical nephroureterectomy from June 1997 to December 1998 and more recent laparoscopic radical nephroureterectomy from January 1999 to October 2000. Yearly financial costs were adjusted for inflation by a 4% annual rate to reflect year 2000 data. RESULTS: For radical nephrectomy mean operative time in the 18 open, 20 initial laparoscopic and 15 recent laparoscopic cases was 185.3, 205.7 and 147.3 minutes, respectively. Mean specimen weight was 555, 616 and 558 gm., and mean hospital stay was 132, 31 and 23 hours, respectively. Compared with open radical nephrectomy mean total costs associated with initial laparoscopy were 33% greater (p = 0.0003). Mean intraoperative costs were 102% greater and mean postoperative costs were 50% less. In contrast, the more recent laparoscopic cases were an overall mean of 12% less expensive than open surgery (p = 0.05). Mean intraoperative costs were only 33% greater and mean postoperative costs were 68% less. For radical nephroureterectomy mean operative time in the 14 open, 14 initial laparoscopic and 14 recent laparoscopic cases was 246, 196 and 195 minutes, respectively. Mean specimen weight was 442, 517 and 531 gm., and mean hospital stay was 142, 63 and 32 hours, respectively. Compared with open radical nephroureterectomy mean total costs associated with initial laparoscopic cases were 28% greater (p = 0.03). Mean intraoperative costs were 65% greater and mean postoperative costs were 27% less. In contrast, the more recent laparoscopic cases were an overall mean of 6% less expensive than open surgery (p = 0.63). Mean intraoperative costs were only 31% greater and mean postoperative costs were 62% less. CONCLUSIONS: Initially in the learning curve laparoscopic radical nephrectomy and nephroureterectomy were 33% and 28% financially more expensive, respectively, than their open counterparts. However, with increased operator experience and efficiency resulting in more rapid operative time and decreased hospitalization laparoscopic radical nephrectomy and nephroureterectomy are currently 12% and 6% less expensive, respectively, than their open counterparts at our institution.     

后腹腔镜辅助小切口肾输尿管及膀胱袖套状切除术(附7例报告)

目的:探讨后腹腔镜辅助小切口肾输尿管及膀胱袖套状切除术的手术技巧。方法:用后腹腔镜辅助小切口为7例肾盂及输尿管肿瘤患者行肾输尿管及膀胱袖套状切除术,其中肾盂癌4例,输尿管癌3例。结果:7例手术均获成功,手术时间90~120min,平均108min,术中出血50~150ml,平均80ml。术后平均住院10d,无严重并发症发生。随访4~33个月,无肿瘤复发。结论:采用后腹腔镜辅助小切口肾输尿管及膀胱袖套状切除术治疗肾盂及输尿管肿瘤具有患者创伤小、出血少、手术时间短、并发症少、切除更完全等优点。     

Laparoscopy-assisted total nephroureterectomy for renal pelvic and/or lower ureteral cancer

PURPOSE: The usefulness of laparoscopy-assisted total nephroureterectomy for patients with renal pelvic and lower ureteral cancer is evaluated. MATERIAL: Seven patients with renal pelvic cancer and four with lower ureteral cancer performed laparoscopy-assisted total nephroureterectomy from May 1997 to December 2000 (Ten males and one female, mean age 68.5 year-old). METHOD: Of the 11 patients, the initial one received preoperative embolization of the renal artery. Under general anesthesia laparoscopy-assisted total nephroureterectomy underwent via transperitoneal approach in three patients and retroperitoneal approach in eight. After the kidney was completely dissected under laparoscopic procedure, it was delivered en bloc with ureter from the skin incision in the lower abdomen. RESULT: Two patients needed conversion to open surgery. The mean operating time of nine patients except for conversion cases was 272 minutes and the mean blood loss was 313 ml. There was no major complication associated with laparoscopic procedure. There was no significant difference in both complication and recurrence rate between laparoscopy-assisted total nephroureterectomy and open surgery. CONCLUSION: Laparoscopy-assisted total nephroureterectomy is an useful procedure for the treatment of patients with renal pelvic and lower ureteral cancer because it enables us to remove out the kidney and ureter from one small lower abdominal incision.