摘要
目的探讨一期腹腔镜肾输尿管全长及膀胱根治性切除术的安全性及可行性。方法回顾性分析2011年6月～2017年6月13例膀胱癌合并肾盂或输尿管病变的资料。男8例,女5例。年龄55～82岁,平均71.5岁。术前均明确为膀胱癌,4例T1N0M0(膀胱多发肿物),8例T2N0M0,1例T2N1M0。考虑合并输尿管占位6例,膀胱肿物累及输尿管口引起肾积水5例,肾萎缩伴积水4例。长期透析3例,肾移植术后2例。ASA分级Ⅰ级1例,Ⅱ级8例,Ⅲ级4例。先行后腹腔镜患肾及输尿管切除(左侧8例,右侧4例,双侧1例),再经腹腔行腹腔镜膀胱癌根治术,女性同时切除子宫,男性切除前列腺,1例同时切除尿道。尿流改道方式:3例透析者未行尿流改道,2例肾移植术后者行Brick膀胱术,余8例行输尿管皮肤造口术。结果手术顺利,其中1例切除肾脏时因粘连较重中转开放。中位手术时间466(337～587)min,出血量250(50～1000)ml,6例输血,中位输血量400(400～1200)ml,中位术后住院时间16(8～28)d。术后病理均为膀胱癌,其中11例尿路上皮癌(低级别1例,高级别10例,1例合并原位癌,1例合并前列腺癌),2例原位癌。除膀胱外,累及输尿管4例,肾盂1例,肾盂、输尿管1例,肾盂、输尿管及尿道1例,其中左侧5例,右侧1例,双侧1例。中位随访22(1～72)个月,2例死亡,11例存活。结论一期腹腔镜肾输尿管全长及膀胱根治性切除是治疗膀胱癌合并肾盂或输尿管病变的有效方式,虽然肿瘤分级高、分期晚、手术时间长,但预后尚可。
Objective To evaluate the safety and feasibility of one-stage laparoscopic nephroureterectomy with cystectomy.Methods A retrospective analysis of 13 patients with bladder tumors and upper urinary tract disease from June 2011 to June 2017 was conducted,including 8 males and 5 females,aged 55-82（ mean,71. 5） years old. The bladder cancer was identified before operation,including 4 cases of stage T1N0M0（ multiple bladder tumors）,8 cases of T2N0M0,and 1 case of T2N1M0. Examinations showed 6 cases of ureter tumor,5 cases of hydronephrosis caused by bladder tumor involving ureter orifice, and 4 cases of hydronephrosis and renal atrophy. There were 3 cases of long-term dialysis and 2 cases of dialysis after renal transplantation.Preoperative ASA grading showed 1 case in grade Ⅰ, 8 cases in grade Ⅱ, and 4 cases in grade Ⅲ. The laparoscopic nephroureterectomy was performed firstly（ left-sided in 8 cases,right-sided in 4 cases,and bilateral in 1 case）,then laparoscopic radical cystectomy for bladder cancer was given（ female cases with hysterectomy,male cases with prostatectomy,and 1 case with urethral resection）. The urinary diversion： 3 dialysis patients were given no urinary diversion,2 renal transplantation patients underwent Brick bladder surgery,and other 8 patients underwent ureterocutaneostomy. Results All the operations were successfully completed,and 1 case was converted to open surgery because of severe adhesion. The operation time was 337-587 min（ median,466 min）,and the blood loss was 50-1000 ml（ median,250 ml）. There were 6 cases of blood transfusion,and the amount of blood transfusion was 400-1200 ml（ median,400 ml）. The postoperative hospital stay was 8-28 days（ median,16 days）. Postoperative pathology was bladder cancer,including 11 cases of urothelial carcinoma（ 1 case in low grade,10 cases in high grade,1 case with carcinoma in situ,and 1 case with prostate cancer）,and 2 cases of carcinoma in situ. Beside bladder cancer,there were 4 cases involving ureter,1 case
作者
邱敏
颜野
段波
侯小飞
马闰卓
卢剑
王国良
张树栋
黄毅
马潞林
Qiu Min;Yah Ye;Duan Bo(Department of Urology,Peking University Third Hospital,Beijing 100191,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2018年第8期686-689,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
膀胱
肾
输尿管
多发肿瘤
Laparoscopy
Bladder
Kidney
Ureter
Multiple tumors
