腔镜治疗输尿管末端结石并无功能肾(附9例报道)  

Endoscopic for the Management of End Ureteral Stones and Nonfunctioning Kidney

作　　者：孙德明[1] 胡传义[1] 李爱军[1] 喻俊峰[1] 蒋林涛[1] 刘昌荣[1] 王进[1] 聂勇[1] 张科[1] 张满[1] 

机构地区：[1]湖北省宜昌市第一人民医院泌尿外科,湖北宜昌443000

出　　处：《临床泌尿外科杂志》2011年第2期108-110,共3页Journal of Clinical Urology

摘　　要：目的:探讨腔镜治疗输尿管末端结石并无功能肾的处理策略。方法:输尿管末端结石并无功能肾9例,术前影像学及尿细胞学检查均未发现肿瘤改变。先以膀胱电切镜经尿道行膀胱袖状切除术,再在B超引导下,经皮细针穿刺抽吸部分肾积水,约1000～2 500 ml,增大后腹腔空间,行后腹腔镜下肾输尿管全切术,最后在下腹部取4～6 cm小切口,将肾、输尿管全长及末端结石完整取出结果:9例患者手术顺利,手术时间150～270min,平均(190.5±23.7)min;估计出血量30～90 ml.平均(54.2±1 3.6)ml;术后7～10天拆线出院。随访6个月～3年,无肿瘤等并发症发生。术后输尿管末端病理检查示:6例慢性炎症;2例慢性炎症并上皮细胞不典型增生;1例输尿管原位癌。结论:输尿管末端结石长期慢性炎性刺激,导致尿路上皮细胞异常增生与癌变。对输尿管末端结石合并无功能肾患者,视同输尿管癌,后腹腔镜联合膀胱电切镜行肾输尿管全长与膀胱袖状切除术,达到微创效果。Objective：To assess the endoscopic for the management of end ureteral stones and nonfunetioning kidney. Methods： From June of 2005 to December of 2009, 9 patients with end ureteral stones and nonfunctioning kidney, preoperative imaging and urine cytology did not discover carcinoma. First transurethral bladder-cuff excision with bladder resectoscope, the needle electrode was used to incise the ureter cuff in bladder 0.5cm away from the ureteral orifice. Transcutaneous B-ultrasound guided fine needle, suction part of the hydronephrosis, about 1000-2500ml, to increase retroperitoneal space. Three trocars in the waist were used for dissecting the kidney. Then the nephroureterectomy was performed laparoscopically through retroperitoneal approach. An incision of 4- 6cm was created in the lower abdomen to allow dissection of the distal ureter and bladder-cuff. Results：The operation was successfully completed in all the 9 patients. The operation time was 150-270 min, average （190.5±23.7） min. The intra-operative estimated blood loss was 30-90ml, average （54.2±13.6） ml, and the postoperative hospital stay was 7-10d. No intra-operative complications were observed, no postoperative complications after six months to three years follow-up. Postoperative pathological examination showed ureteral end of the specimen, 6 cases of chronic inflammation, 2 cases of chronic inflammation and epithelial cell dysplasia, 1 case of ureteral carcinoma in situ. Conclusions：End ureteral stones stimulate long-time chronic inflammation, lead to urinary tract epithelial cell dysplasia and cancer. End ureteral stones and nonfunctioning kidney in patients shuld be seen as ureteral cancer. Retroperitoneoscopic nephroureterectomy with transurethral bladder-cuff excision for end ureteral stones and nonfunctioning kidney, has a minimally invasive effect.

关 键 词：输尿管末端结石 无功能肾 原位癌 腹腔镜术 膀胱袖状切除术 

分 类 号：R693.4[医药卫生—泌尿科学]