后腹腔镜联合经尿道电切镜治疗上尿路移行细胞癌(附83例报告)

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1.5 cm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7 d.11例术后辅助放疗. 结果 83例手术均成功.手术时间115～205 min,平均156 min.术中出血50～150 ml,平均80 ml.无术中并发症.术后住院7～11 d,平均8.5 d.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（pT3 G3和pT2 G3）于术后3个月肝转移.2例输尿管中段肿瘤（pT3 G3和pT3 G2～3）术后6个月原位复发并肺转移.1例输尿管下段肿瘤（pT3 G3）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.

Retroperitoneal Laparoscopic Total Nephroureterectomy with Resectoscopic Excision of Bladder Cuff for Upper Urinary Tract Transitional Cell Carcinoma: A Report of 83 Cases

Objective To evaluate the outcome and the feasibility of retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff for upper urinary tract transitional cell carcinoma.Methods A total of 83 patients with upper urinary tract transitional cell carcinoma underwent retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff from March 2003 to July 2006.The bladder cuff was transurethrally resected for 1.5 cm in circumference from the ureteric orifice.Then the total nephroureterectomy was performed laparoscopically through retroperitoneal approach.Intraurethral catheter was indwelled for 7 days postoperatively.Adjuvant radiotherapy was given in 11 patients.Results The operation was successfully completed in all the 83 patients.The operation time was 115-205 min(mean,156 min),the intraoperative estimated blood loss was 50-150 ml(mean,80 ml),and the postoperative hospital stay was 7-11 d(mean,8.5 d).Follow-up examinations were conducted for 3-38 months(mean,10.8 months).Pathological findings revealed transitional cell carcinoma in 82 patients and moderate-to-severe atypical hyperplasia of the renal pelvis epithelium in 1 patient.Cystoscopic examinations within 12 months postoperatively found bladder tumors in 6 patients,5 of whom underwent transurethral resection of tumor and 1 of whom was given laparoscopic en bloc cystectomy with left cutaneous ureterostomy.Liver metastasis was found in 2 patients with tumor of renal pelvis(pT3G3 and pT2G3)3 months after operation.Local recurrence and lung metastasis was found in 2 patients with tumor in middle segment of the ureter(pT3G3 and pT3G2-3)6 months after operation.Bone metastasis was found in 1 patient with tumor in lower segment of the ureter(pT3G3)6 months after operation.There was 1 case of loss to follow-up,while in the remaining 71 cases no recurrence or metastasis was seen.Conclusions Retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff appears to be a technically feasible operation for upper urinary tract transitional cell carcinoma,which is worthy of clinical application.