完全腹腔镜下上尿路尿路上皮癌根治术12例分析

摘要

目的：探讨完全腹腔镜肾、输尿管全长切除+膀胱部分切除术治疗上尿路尿路上皮癌的疗效及临床价值。方法12例上尿路尿路上皮癌患者在我院接受完全腹腔镜下肾盂、输尿管癌根治术,肾盂癌8例,输尿管癌4例,其中2例输尿管癌突入膀胱内。术中采用70°健侧卧位,建立人工气腹,置5枚套管,首先在肾周筋膜外行患侧肾切除,再游离输尿管至膀胱,其中肾盂癌或输尿管癌未侵入膀胱病例切开部分逼尿肌,将输尿管开口及部分膀胱黏膜拉出膀胱壁外,Hem-o-lock夹毕切断；输尿管癌侵入膀胱病例术前膀胱内保留灌注100 mL稀释后的50 mg羟基喜树碱,切开膀胱前将灌注液自导尿管放出,沿输尿管膀胱入口处周围2 cm环形切除膀胱壁及输尿管开口处肿瘤,2-0可吸收线缝合膀胱。结果该组病例均成功完成手术,无中转开放手术。手术时间150~200 min,平均170 min；术中出血80~150 mL,平均95 mL；无严重围手术期并发症。术后住院时间6~9 d,平均7 d,术后病理均为尿路上皮癌。8例患者术后辅以4次GC方案全身化疗。术后随访2~30个月,1例术后7个月因膀胱内肿瘤复发行经尿道膀胱肿瘤电切术,其余患者未见肿瘤复发、转移。结论完全腹腔镜下上尿路尿路上皮癌根治术临床疗效满意,同时具有创伤小、不需要术中更换体位、术后恢复快等优点,值得临床推广应用。%Objective To explore the efficacy and clinical value of totally laparoscopic radical resection of the kidney and ureter and partial resection of the bladder in the treatment of upper urinary tract urothelial carcinoma. Methods A total of 12 patients underwent totally laparoscopic radical resection of the renal pelvis and ureter in our hospital, including eight cases of renal pelvis cancer and four cases of ureter cancer, in which two cases of ureteral cancer were immersed into the bladder. The patients were in the healthy lateral position at 70°. The ar-tificial pneumoperitoneum was established, where set five cannulas. Nephrectomy was first given outside of the perirenal fascia, and then the ureter was dissociated to the bladder. For patients without invasion of renal pelvis or ureter cancer into the bladder, part of the detrusor mus-cle was cut open, and the opening of ureter and part of the bladder mucosa were pulled out of the bladder wall, which were clipped off by Hem-o-lock. For patients with invasion of renal pelvis cancer into the bladder, 100 mL of diluted 50 mg hydroxycamptothecin was infused and reserved in the bladder before surgery. The perfusate was released from the urethral catheter prior to bladder incision. The tumors located on the bladder wall and the opening of ureter were given ring resection 1 cm around the opening of ureter and bladder, and the bladder was su-tured with 2-0 absorbable thread. Results These patients underwent successful surgery without conversion to open surgery. The duration of operation was between 150 and 200 mins, and the average time was 170 mins. The intraoperative blood loss was between 80 and 150 mL, and the average blood loss was 95 mL. There were no serious perioperative complications. Postoperative hospital stay was between 6 and 9 days, and the average hospital stay was 7 days. Postoperative pathology showed urothelial carcinoma in all patients. 8 patients were supplemented with GC systemic chemotherapy for four times after surgery. Patients were followed up between 2 and 30 months. One patient received TURBT surgery after seven months due to the recurrence of bladder, and the remaining patients had no tumor recurrence or metastasis. Conclusion Totally laparoscopic upper urinary tract urothelial carcinoma has a satisfactory clinical efficacy, with advantages of less trauma, unnecessary intraoperative replacement of the position and quick postoperative recovery, thus it is worth clinical popularization and application.