经尿道输尿管下段钬激光切除术治疗肾盂输尿管癌

摘要

目的：探讨上尿路尿路上皮癌（ upper urinary tract urothelial carcinoma，UUT－UC）根治术中经尿道膀胱镜下行袖套状膀胱、输尿管下段切除的可行性。方法回顾性分析2003年7月～2011年12月76例肾盂癌、中上段输尿管癌患者的资料。按医生建议和患者意愿分为2组。膀胱、输尿管下段切除分别采用经尿道膀胱镜下钬激光袖套状切除（膀胱镜组，36例）和开放手术（开放组，40例），肾切除均为开放手术。对2组手术时间、术后下床时间和术后住院时间进行比较。结果2组手术均顺利完成，无并发症。与开放组相比，膀胱镜组手术时间短[（177．2±36．9） min vs．（229．6±28．1） min， t＝－7．004， P＝0．000]，下床活动早[（2．7±0．7） d vs．（4．1±1．0） d， t＝－6．802， P＝0．000]，住院时间短[（6．9±1．0） d vs．（8．6±1．5） d， t＝－5．448， P＝0．000]。2组术后随访6～120个月，中位数32个月，未见转移和复发。结论经尿道术式的创伤程度、术后恢复时间等优于传统开放手术。经尿道膀胱镜钬激光袖套状切除膀胱、输尿管下段是肾盂癌和输尿管癌根治术中微创、安全的方法。%Objective To explore the feasibility of transurethral resection of the distal ureter and bladder cuff in radical nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma ( UUT-UC) . Methods A total of 76 patients with renal pelvic carcinoma or upper tract urothelial carcinoma from July 2003 to December 2011 were retrospectively analyzed.All the patients were divided into two groups according to doctor’ s suggestion and patient’ s wishes.Thirty-six patients received excision of the distal ureter and bladder cuff by transurethral Holmium laser combined with open nephroureterectomy ( cystoscopy group) , while 40 patients underwent open surgery ( open surgery group) .The operation time, postoperative activity time, and postoperative hospital stay were compared between the two groups. Results All the operations were completed successfully in both groups.As compared with the open surgery group, the cystoscopy group had shorter operation time [(177.2 ±36.9) min vs.(229.6 ±28.1) min, t =-7.004, P=0.000], postoperative activity time [(2.7 ±0.7) d vs.(4.1 ±1.0) d, t=-6.802, P=0.000], and hospital stay [(6.9 ±1.0) d vs.(8.6 ±1.5) d, t=-5.448, P=0.000].No recurrence or metastasis was observed during a follow-up for 6-120 months ( median, 32 months) in the two groups. Conclusions Transurethral surgery is superior to traditional open surgery in trauma degree and postoperative recovery time.Transurethral Holmium laser resection of the distal ureter and bladder cuff is a minimally invasive and safe technique in the nephroureterectomy for the treatment of UUT-UC.