腹腔镜手术治疗上尿路移行细胞癌不同路径的选择和应用  

Application of different operative approaches for laparoscopic treatment of upper urinary tract transitional cell carcinoma

作　　者：杨典东[1] 高振利[1] 林春华[1] 姜仁慧[1] 奉友刚[1] 王建明[1] 王琳[1] 石磊[1] 门昌平[1] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院泌尿外科,264000

出　　处：《中华泌尿外科杂志》2008年第11期759-762,共4页Chinese Journal of Urology

摘　　要：目的比较腹腔镜下手术治疗上尿路移行细胞癌的不同路径、输尿管处理方法及其适应证。方法94例上尿路移行细胞癌患者，均行肾、输尿管切除并膀胱袖状切除。分2组：①A组63例，为肾盂及输尿管上段肿瘤患者，采用后腹腔镜联合经尿道电切法；②B组31例，为输尿管中下段肿瘤患者及6例输尿管局部浸润患者，采用70°斜卧位经腹腔途径。观察2组手术时间、术中出血量、术后肠道功能恢复时间及术后并发症等。结果94例手术均成功，无术中并发症。2组平均手术时间分别为156和161min，平均术中出血量分别为80和86ml，术后胃肠功能恢复时间分别为24～48和24-72h，术后平均住院时间分别为8．0和8．5d。A组发生尿外渗2例，放置腹膜后引流管7d愈合；形成尿囊肿1例，B超引导下穿刺引流治愈。84例获随访，平均随访23个月。2组分别有3例和5例膀胱镜检查发现膀胱肿瘤，2组均无切口及穿刺孔种植转移。结论腹腔镜下肾、输尿管全切和膀胱袖状切除治疗上尿路移行细胞癌安全可行，应根据肿瘤位置和是否发生局部浸润来选择手术方式。Objective To analyze the different approaches and their indications in the laparoscopic treatment of upper urinary tract transitional cell carcinoma. Methods 94 patients with upper urinary tract transitional cell carcinoma were divided to two groups. Group A （63 cases） with renal pelvic and upper ureteral carcinoma were treated with retroperitoneal approach laparoscopic surgery and transurethral resectoscope surgery. Group B （31 cases） with middle ureteral carcinoma including 6 cases with ureteral local infiltration were treated through 70° recumbent position transperitoneal approach laparoscopic surgery combined with bladder cuff resection. The operative time, blood loss, the intestinal functional recovery time and post-operative complications were recorded. Results All 94 procedures were successfully completed, with no complication during the surgery. The mean operation time of A and B group was 156.5 and 160.8 min;the mean blood loss was 80 and 86 ml; the mean hospital stay was 8 and 8.5 d; the time of bowel functional recovery of group A and group B was 24-4：8 and 24-72 h, respectively. 84 cases were followed-up with mean follow-up time of 23 months. Three cases and 5 cases were found having bladder tumor in the group A and group B. The incision and port metastasis was not found. Conclusions It is safe and feasible to treat the upper urinary tract transitional cell carcinoma laparoscopically. The selection of operating approach is mainly based on the location and local infiltration status of the tumor.

关 键 词：上尿路移行细胞癌 腹腔镜 手术路径 

分 类 号：R737.1[医药卫生—肿瘤] R614[医药卫生—临床医学]