[1]石磊,高振利,姜仁慧,等.后腹腔镜联合经尿道电切镜治疗上尿路移行细胞癌（附83例报告）[J].中国微创外科杂志,2007,07(8):735-737.
　Shi Lei,Gao Zhenli,Jiang Renhui,et al.Retroperitoneal Laparoscopic Total Nephroureterectomy with Resectoscopic Excision of Bladder Cuff for Upper Urinary Tract Transitional Cell Carcinoma: A Report of 83 Cases[J].Chinese Journal of Minimally Invasive Surgery,2007,07(8):735-737.
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后腹腔镜联合经尿道电切镜治疗上尿路移行细胞癌（附83例报告）()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
07
期数:
2007年8期
页码:
735-737
栏目:
出版日期:
2007-08-20

文章信息/Info

Title:
Retroperitoneal Laparoscopic Total Nephroureterectomy with Resectoscopic Excision of Bladder Cuff for Upper Urinary Tract Transitional Cell Carcinoma: A Report of 83 Cases
作者:
石磊; 高振利; 姜仁慧; 王建明; 王琳; 杨典东; 孙德康; 刘庆祚; 吴吉涛; 门昌平; 张鹏
青岛大学医学院附属烟台毓璜顶医院泌尿外科，烟台264000
Author(s):
Shi Lei;  Gao Zhenli;  Jiang Renhui;  et al.
Department of Urology, Yuhuangding Hospital of Qingdao University Medical School, Yantai 264000, China
关键词:
肾盂; 输尿管; 移行细胞癌; 电切
Keywords:
Renal pelvis; Ureter; Transitional cell carcinoma; Electrocision
分类号:
R737.11；R737.13
文献标志码:
A
摘要:
目的探讨后腹腔镜联合经尿道电切镜治疗上尿路移行细胞癌的效果和安全性。方法2003年3月～2006年7月，我院采用后腹腔镜联合经尿道电切镜治疗83例上尿路移行细胞癌。经尿道袖状电切患侧输尿管口周围1.5 cm范围膀胱壁达膀胱外脂肪组织，采用后腹腔镜切除肾及全长输尿管。术后留置导尿管7 d。11例术后辅助放疗。 结果83例手术均成功。手术时间115～205 min，平均156 min。术中出血50～150 ml，平均80 ml。无术中并发症。术后住院7～11 d，平均8.5 d。病理报告：82例上尿路移行细胞癌，1例肾盂上皮中～重度不典型增生。术后随访3～38个月，平均10.8月。术后12个月内行膀胱镜检查发现膀胱肿瘤6例，其中5例行经尿道膀胱肿瘤电切，1例行腹腔镜根治性膀胱全切术、左侧输尿管皮肤造口术。2例肾盂肿瘤（pT3 G3和pT2 G3）于术后3个月肝转移。2例输尿管中段肿瘤（pT3 G3和pT3 G2～3）术后6个月原位复发并肺转移。1例输尿管下段肿瘤（pT3 G3）术后6个月骨转移。失访1例。其余71例均未发现肿瘤复发、切口转移及远处转移。结论对于上尿路移行细胞癌，采用后腹腔镜联合经尿道电切镜行肾、输尿管全切及膀胱袖套状切除具有创伤小、安全、恢复快等优点，值得临床推广应用。
Abstract:
ObjectiveTo evaluate the outcome and the feasibility of retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff for upper urinary tract transitional cell carcinoma.MethodsA total of 83 patients with upper urinary tract transitional cell carcinoma underwent retroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff from March 2003 to July 2006. The bladder cuff was transurethrally resected for 1.5 cm in circumference from the ureteric orifice. Then the total nephroureterectomy was performed laparoscopically through retroperitoneal approach. Intraurethral catheter was indwelled for 7 days postoperatively. Adjuvant radiotherapy was given in 11 patients.ResultsThe operation was successfully completed in all the 83 patients. The operation time was 115-205 min (mean, 156 min), the intraoperative estimated blood loss was 50-150 ml (mean, 80 ml), and the postoperative hospital stay was 7-11 d (mean, 8.5 d). Followup examinations were conducted for 3-38 months (mean, 10.8 months). Pathological findings revealed transitional cell carcinoma in 82 patients and moderatetosevere atypical hyperplasia of the renal pelvis epithelium in 1 patient. Cystoscopic examinations within 12 months postoperatively found bladder tumors in 6 patients, 5 of whom underwent transurethral resection of tumor and 1 of whom was given laparoscopic en bloc cystectomy with left cutaneous ureterostomy. Liver metastasis was found in 2 patients with tumor of renal pelvis (pT3G3 and pT2G3) 3 months after operation. Local recurrence and lung metastasis was found in 2 patients with tumor in middle segment of the ureter (pT3G3 and pT3G2-3) 6 months after operation. Bone metastasis was found in 1 patient with tumor in lower segment of the ureter (pT3G3) 6 months after operation. There was 1 case of loss to followup, while in the remaining 71 cases no recurrence or metastasis was seen. ConclusionsRetroperitoneal laparoscopic total nephroureterectomy with resectoscopic excision of bladder cuff appears to be a technically feasible operation for upper urinary tract transitional cell carcinoma, which is worthy of clinical application.

参考文献/References:

[1]Clayman RV,Kavoussi LR,Figenshau RS,et al.Laparoscopic nephroureterectomy:initial clinical case report.J Laparoendosc Surg，1991，1:343-349.
[2]Shalhav AL，Dunn MD，Portis AJ，et al.Laparoscopic nephroureterectomy for upper tract transitional cell cancer.The Washington University experience.J Urol，2000，163：1100-1104.
[3]石磊，高振利，王琳，等.腰部切口联合经尿道电切肾、输尿管全切术.中国微创外科杂志，2005，5:454-455.
[4]Tsujihata M，Nonomura N，Tsujimura A，et al.Laparoscopic nephroureterectomy for upper tract transitional cell carcinoma:comparison of laparoscopic and open surgery.Eur Urol，2006，49: 332-336.
[5]Rassweiler JJ，Schulze M，Marrero R，et al.Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: is it better than open surgery?Eur Urol，2004，46: 690-697.
[6]Bariol SV，Stewart GD，McNeill SA，et al.Oncological control following laparoscopic nephroureterectomy:7year outcome.J Urol，2004,172:1805-1808.
[7]Wolf JS Jr，Dash A，Hollenbeck BK，et al.Intermediate followup of hand assisted laparoscopic nephroureterectomy for urothelial carcinoma: factors associated with outcomes.J Urol，2005，173:1102-1107.
[8]Tan BJ，Ost MC，Lee BR.Laparoscopic nephroureterectomy with bladdercuff resection: techniques and outcomes.J Endourol，2005，19:664-676.
[9]Hattori R，Yoshino Y，Gotoh M，et al.Laparoscopic nephroureterectomy for transitional cell carcinoma of renal pelvis and ureter:Nagoya experience.Urology，2006，67: 701-705.
[10]丘少鹏，陈羽，陈炜，等.腹腔镜肾盂癌手术的初步经验(附10例报告).中国内镜杂志，2003，9（12）：35-37.
[11]黄健，许可慰，韩金利，等.完全腹腔镜下肾输尿管全切（附9例报告）.中国内镜杂志,2004，10（11）：25-27.
[12]邢金春，陈斌，陈实新，等.手助腹腔镜根治性肾输尿管全切术治疗上尿路.临床泌尿外科杂志,2004，19：536-538.
[13]Kurzer E，Leveillee RJ，Bird VG.Combining hand assisted laparoscopic nephroureterectomy with cystoscopic circumferential excision of the distal ureter without primary closure of the bladder cuff:is it safe?J Urol，2006,175:63-67.
[14]Vardi IY,Stern JA,Gonzalez CM,et al.Novel technique for management of distal ureter and en block resection of bladder cuff during handassisted laparoscopic nephroureterectomy.Urology,2006，67:89-92.

更新日期/Last Update: 2013-12-09