腹腔镜下超声刀小儿肾输尿管切除术

目的：探讨腹腔镜下超声刀小儿肾输尿管切除手术的操作特点及疗效。方法：对5例肾发育不全、多房性肾囊性变和重复肾合并输尿管异位开口的病孩，使用微型腹腔镜及超声刀技术施行肾输尿管切除术或部分肾及输尿管切除术。结果：5例手术均获成功。手术耗时105－268分钟，平均152分钟。术中出血不少15ml,术后无继发性出务、无手术合并症。结论：腹腔镜超声刀技术能安全、有效地应用于肾或部分肾输尿管切除术，有利于病孩术后的恢复。     

经腹与经后腹腔入路腹腔镜手术治疗上尿路上皮癌的疗效比较

目的探讨经腹腔入路与经后腹腔入路手术治疗上尿路上皮癌的疗效。方法回顾性分析四川省人民医院收治的上尿路上皮癌患者33例,依据手术方法不同分为经后腹腔入路21例与经腹腔入路组12例。比较两组患者的一般资料,围术期及术后相关指标。结果两组患者在年龄、肿瘤部位、肿瘤大小、术后住院时间、手术时间、术后膀胱肿瘤复发及远处转移等方面差异无统计学意义(P>0.05),但经后腹腔入路组术中失血量少于腹腔入路组,引流管拔除时间短于腹腔入路组,差异有统计学意义(P<0.05)。结论经腹腔入路与经后腹腔入路手术治疗上尿路上皮癌,均是安全、有效的,但各有利弊。     

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。     

A Systematic Review and Meta-analysis of Adjuvant and Neoadjuvant Chemotherapy for Upper Tract Urothelial Carcinoma

Context

The role of adjuvant chemotherapy (AC) or neoadjuvant chemotherapy (NC) remains poorly defined for the management of upper tract urothelial carcinoma (UTUC), although some studies suggest a benefit.

Objective

To update the current evidence on the role of NC and AC for UTUC patients.

Evidence acquisition

We searched for all studies investigating NC or AC for UTUC in Medline, Embase, the Cochrane Central Register of Controlled Trials, and abstracts from the American Society of Clinical Oncology meetings prior to February 2014. A systematic review and meta-analysis were performed.

Evidence synthesis

No randomized trials investigated the role of AC for UTUC. There was one prospective study (n = 36) investigating adjuvant carboplatin–paclitaxel and nine retrospective studies, with a total of 482 patients receiving cisplatin-based or non-cisplatin–based AC after nephroureterectomy (NU) and 1300 patients receiving NU alone. Across three cisplatin-based studies, the pooled hazard ratio (HR) for overall survival (OS) was 0.43 (95% confidence interval [CI], 0.21–0.89; p = 0.023) compared with those who received surgery alone. For disease-free survival (DFS), the pooled HR across two studies was 0.49 (95% CI, 0.24–0.99; p = 0.048). Benefit was not seen for non-cisplatin–based regimens. For NC, two phase 2 trials demonstrated favorable pathologic downstaging rates, with 3-yr OS and disease-specific survival (DSS) ≤93%. Across two retrospective studies investigating NC, there was a DSS benefit, with a pooled HR of 0.41 (95% CI, 0.22–0.76; p = 0.005).

Conclusions

There appears to be an OS and DFS benefit for cisplatin-based AC in UTUC. This evidence is limited by the retrospective nature of studies and their relatively small sample size. NC appears to be promising, but more trials are needed to confirm its utility.

Patient summary

After a comprehensive search of studies examining the role of chemotherapy for upper tract urothelial cancer, the pooled evidence shows that cisplatin-based adjuvant chemotherapy was beneficial for prolonging survival.     

Risk factors for intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma: A meta-analysis

PurposeAfter radical nephroureterectomy (RNU), approximately 22% to 47% of patients with upper tract urothelial carcinoma (UTUC) develop a subsequent intravesical recurrence (IVR). Considering this high incidence of occurrence, several risk factors were reported as predictive of IVR after RNU. Until recently, most of the risk factors were still under debate. The aim of study was to conduct a meta-analysis based on the recent literature to explore the risk factors for IVR after RNU for UTUC.Patients and methodsAn electronic search of the Medline, Embase, Cochrane Library, CancerLit, and ClinicalTrials.gov databases was performed to identify relevant studies published before May 2013. The studies were included if they reported risk factors related to bladder or IVR after RNU for UTUC.ResultsOverall, 40 studies, with 12,010 patients, were included in our meta-analysis. Our study indicated that a statistically significant difference in IVR after RNU was found in the male vs. female patients (odds ratio [OR] = 0.72, 95% CI: 0.59–0.85), ureteral vs. renal pelvis (OR = 1.18, 95% CI: 1.00–1.36), T2–4 vs. Tis, Ta, and T1 (OR = 0.53, 95% CI: 0.40–0.66), larger vs. smaller tumor size (OR = 1.02, 95% CI: 1.01–1.03), and previous/synchronous bladder cancer vs. the absence of bladder cancer (OR = 1.59, 95% CI: 1.26–1.9). No significant differences in IVR after RNU were found in the younger vs. older age groups, multifocal tumors vs. single tumor, G3 vs. G1 and G2, high vs. low grade, N0 vs. N+, concomitant carcinoma in situ vs. the absence of carcinoma in situ, positive vs. negative lymphovascular invasion, open vs. laparoscopic nephroureterectomy, and endoscopic vs. transvesical technique.ConclusionsOur study showed that female patient; ureteral tumor; larger tumor; Tis, Ta, and T1; and the history of bladder cancer were significant risk factors related to IVR after RNU.     

后腹腔镜下肾输尿管全切除术治疗低分化肾盂癌:与开放手术的比较

目的 通过与开放手术比较,评价后腹腔镜手术治疗低分化肾盂癌的临床应用价值.方法 肾盂癌患者33例,病理为肿瘤局限于肾脏(T1N0M0～T3N0M0),细胞分化3级.12例行后腹腔镜下肾输尿管全切联合下腹部小切口切除患侧输尿管口,21例行开放性肾盂癌根治术,比较2组的临床疗效.结果腹腔镜组和开放手术组的平均手术时间分别为(232±36)和(212±17)min(P=0.100),术中平均出血量分别为(162±64)和(233±51)ml(P=0.001),术后肠道恢复时间为(2.5±0.5)和(3.9±0.3)d(P＜0.001),术后平均住院时间为(7.6＜0.9)和(9.8±1.1)d(P＜0.001).术后随访7～67个月,腹腔镜组患者无肿瘤复发或转移;开放组患者中术后1年腹膜后复发1例,发生浅表性膀胱癌3例,无患者死亡.结论 后腹腔镜联合下腹部小切口的肾盂癌根治术能有效治疗肿瘤局限但细胞分化差的患者,且创伤小、患者恢复快.     

后腹腔镜根治性肾输尿管切除术21例报告

目的:探讨后腹腔镜根治性肾输尿管切除术的疗效。方法:2003年10月至2006年10月我们对21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13例,输尿管癌8例。经尿道输尿管口切除术处理末段输尿管,使用Hem-O-lock结扎锁处理肾动静脉。结果:本组手术时间180-300m in,平均220m in;出血量40-100m l,平均60m l;术中、术后未发生明显并发症。随访2-35个月,2例发生膀胱移行细胞癌。结论:后腹腔镜根治性肾输尿管切除术具有创伤小、术后恢复快等优点,用Hem-O-lock结扎锁处理肾动静脉安全可靠,经济实用。     

完全后腹腔镜下肾盂输尿管癌根治性切除术

目的 探讨完全后腹腔镜下肾盂输尿管癌根治性切除术的手术方法及临床应用价值。方法 2003年3月-2005年12月对16例肾孟输尿管癌患者行完全后腹腔镜下根治性切除术。男10例，女6例，肾盂癌11例。输尿管癌5例。均因无痛性肉眼全程血尿就诊。经KUB＋IVP、CT、BUS、逆行上尿路插管造影及输尿管镜检诊断肾盂或输尿管癌。结果 16例手术均取得成功，无中转开放者，手术时间120～200min，平均150mill；术中出血60～120mL，平均70mL；术后住院天数7～10d，平均8d；术中术后无明显并发症，术后随诊3～30个月，未见局部肿瘤复发及膀胱内新发肿瘤。结论 完全后腹腔镜下肾盂输尿管癌根治性切除术方法可行，疗效肯定，具有微创、术后恢复快等优势，将成为治疗上尿路移行细胞癌较理想的手术方法。     

A Ureteral Small Cell Carcinoma Mixed with Malignant Mesodermal and Ectodermal Elements: A Clinicopathological, Morphological and Immunohistochemical Study

A 60-year-old male with a small cell carcinoma of the rightlower ureter is presented. The tumor mainly comprised a smallcell carcinoma but also included a full variety of histologicaltypes such as transitional cell carcinoma, squamous cell carcinoma,adenocarcinoma, leiomyosarcoma and chondrosarcoma. Immunohistochemicalstaining was positive for neuron specific enolase and cluster1 small cell lung cancer antigen/N-CAM in the small cell carcinomaand S-100 in the chondrosarcoma component. The patient underwenta right nephroureterectomy, and received prophylactic radiationof the pelvic and para-aortic lymph node regions and cisplatinand etoposide combination chemotherapy. Eight months after thechemotherapy, a transitional cell carcinoma was found in thebladder neck, and a cystectomy with urethrectomy performed.To our knowledge, this is the second report of a small cellcarcinoma originating from the ureter.