| 刘平辉,汤海龙,王凡.完全经腹腹腔镜下肾盂输尿管癌根治性切除术(附14例报道)[J].浙江中西医结合杂志,2017,27(6): |
| 完全经腹腹腔镜下肾盂输尿管癌根治性切除术(附14例报道) |
| Total Transperitoneal Laparoscopic Nephroureterectomy for Renal Pelvic Carcinoma and Ureteral Carcinoma: Report of 14 Cases |
| 投稿时间：2017-03-05 修订日期：2017-03-05 |
| DOI： |
| 中文关键词: 腹腔镜 肾输尿管全切术 肾盂癌 输尿管癌 |
| 英文关键词:Laparoscopy Nephroureterectomy Renal pelvic carcinoma Ureteral carcinoma |
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| 中文摘要: |
| 【】目的 探讨完全经腹腹腔镜肾盂输尿管癌根治术治疗肾盂癌和输尿管癌的疗效。 方法 2013年2月-2016年12月行完全腹腔镜肾盂输尿管癌根治术14例。术中取70°-90°健侧卧位,建立人工气腹,于脐缘、平脐腋前线、锁骨中线肋缘下和脐与耻骨联合连线中点置入Trocar,先在肾周筋膜外切除肾脏后,向下游离输尿管至膀胱壁段,膀胱充水后打开膀胱,吸净液体,观察双侧输尿管开口, 袖套状切除患侧输尿管,2-0可吸收线连续缝合膀胱切口,下腹部取6-7 cm切口取出标本。 结果 14例手术均获成功,无中转开放病例。手术时间90-170min,平均(105.5±31.4)min。术中出血50-150ml,平均(80.4±21.3)ml。术后2-4 d拔除引流管。术中、术后无明显手术并发症。术后住院时间7-9 d。14例病理诊断均为尿路上皮癌。随访4-48个月,平均25.4月, 1例于术后15个月发现膀胱肿瘤,行经尿道膀胱肿瘤电切术,另1例术后11个月死于全身骨转移和肺转移,其余均无瘤生存。结论 完全腹腔镜下肾盂输尿管癌根治性切除术方法可行,具有微创、术后恢复快等优势,是一种安全、有效的治疗方法。 |
| 英文摘要: |
| Objective To evaluate the method of surgical technique and clinical value of total transperitoneal laparoscopic nephroureterectomy for renal pelvic carcinoma and ureteral carcinoma． Methods We performed total transperitoneal laparoscopic nephroureterectomy in 14 cases since February 2013 to December 2016．Pneumoperitoneums were built with the patients lying at the healthy side at 70°-90°,and then placed four trocars through the incisions at the umbilical edge,anterior axillary line at the umbilical level,midclavicular line at the costal margin level,and middle point between the umbilicus and public symphysis． After removing the kidney,we separated the ureter down to the bladder wall,and then opened the bladder after infusion． Afterwards,the affected ureter was cut,the bladder was closed with 2-0 absorbable suture． The specimen was finally removed through a 6 to 7 cm incision． Results The operation was successfully completed in all the 14 cases without conversion to open surgery． The operation time was 90-170 min with a mean of (105.5±31.4) min; and the blood loss was 50-150 ml ( mean,(80.4±21.3)ml) ． The drainage tube was removed at 2-4 d postoperatively． The hospital stay ranged from 7-9 d． Pathological examination showed that 14 cases were urothelial cancer． All the patients had no obvious complication during and after the operation． All the patients were followed up for 4-48 months with a mean of 25.4 months,during which 1patient was found bladder cancer at 15 months postoperatively and transurethral resection of the bladder tumor was performed; another patient died of bone metastasis and lung metastasis,the others survived without tumor． Conclusions The method of totally transperitoneal laparoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter is less traumatic with rapid recovery and slight pain． It is a safe and effective method for the treatment of upper urinary tract urothelial carcinoma． |
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