摘要
目的探讨肾移植术后发现原肾肾盂癌和（或）输尿管癌一期行后腹腔镜双侧肾输尿管全长切除术的安全性与可行性。方法 2006年4月~2009年11月对8例肾移植术后发现原肾肾盂癌和（或）输尿管癌行腹腔镜下双侧一期肾输尿管全长切除。先取左侧卧位,后腹腔镜下游离右侧肾及输尿管,输尿管远端用钛夹夹闭;改为右侧卧位后同法处理左侧肾及输尿管;然后取截石位,经尿道用电切镜袖状切除双侧输尿管膀胱膀胱壁内段;最后取下腹正中6 cm切口取出标本。结果 8例均行后腹腔镜双侧肾输尿管全长切除联合经尿道膀胱袖状切除,其中1例因膀胱内发现肿物同时行经尿道膀胱电切术,无中转开腹。手术时间（346.9±105.4）min（230~574 min）;术中出血量（162.5±102.6）ml（100~400 ml）,均无输血;住院时间（18.3±5.7）d（12~49 d）。病理报告均为尿路上皮癌,其中2例为双侧病变,此2例中有1例合并膀胱癌。8例随访（22.6±14.2）月（6~49个月）,其中〉1年6例,均存活,1例膀胱癌复发相继行电切、膀胱部分切除治疗。结论肾移植术后原肾肾盂癌或输尿管癌一期行后腹腔镜双侧肾输尿管全长切除术是一种安全可行的治疗方式。
Objective To evaluate the safety and feasibility of bilateral retroperitoneoscopic nephroureterectomy with bladder cuff excision in renal transplant recipients with carcinoma of bilateral renal pelvis and/or ureter. Methods During April 2006 to November 2009,8 cases received bilateral retroperitoneoscopic nephroureterectomy in our department.With the patient being placed in the left lateral decubitus position,their right kidney and ureter were laparoscopically dissected,and the distal ureter was clipped by a metallic clip.Then the patients were changed to the right lateral decubitus position for left nephroureterectomy,which was carried out as the right one.Cystoscopic resection of the bilateral ureteral orifice with bladder cuff was performed,and a 6-cm midline lower abdominal incision was made for removing the specimen. Results All the operations were successfully completed.The patients underwent retroperitoneoscopic bilateral nephroureterectomy ＋ transurethral resection of the ureteral orifice with bladder cuff.And one of them underwent TURBT at the same time.The mean operation time was（346.9±105.4） minutes（ranged from 230 to 574 minutes）,and mean blood loss was（162.5±102.6） ml（100-400 ml）.None of them was converted to open operation or needed blood transfusion,and the mean hospital stay was（18.3±5.7） d（12-49 d）.Pathologic result was transitional cell carcinoma in all the cases（2 of them were bilateral,and 1 of the 2 patients was with bladder cancer）.All the patients were followed up for（22.6±14.2） months（6-49 months）.During the period,one patient had bladder cancer recurrence,and thus underwent TURBT and partial cystectomy. Conclusion Retroperitoneoscopic bilateral nephroureterectomy and bladder cuff excision synchronously is a safe and feasible method for carcinoma of native renal pelvic and/or ureteral in renal transplant recipients.
出处
《中国微创外科杂志》
CSCD
2010年第10期865-867,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
肾移植
肾盂癌
输尿管癌
后腹腔镜手术
Kidney transplantation
Renal pelvis
Ureter
Carcinoma
Retroperitoneoscopic surgery
