腹腔镜手术治疗肾移植后自体上尿路上皮癌九例  

Laparoscopic nephroureterectomy for native upper tract urothelial carcinoma in renal transplant recipients

作　　者：杨典东[1] 高振利[1] 林春华[1] 于胜强[1] 万峰春[1] 柳东夫[1] 王科[1] 吴吉涛[1] 

机构地区：[1]山东省烟台毓璜顶医院泌尿外科,264000

出　　处：《中华器官移植杂志》2012年第1期25-27,共3页Chinese Journal of Organ Transplantation

摘　　要：目的探讨腹腔镜治疗肾移植术后尿路上皮癌的效果。方法1130例肾移植受者中9例（0．8％，9／1130）发生自体上尿路上皮癌，其中右侧输尿管肿瘤2例，右侧肾盂肿瘤2例，左侧肾盂肿瘤2例，左侧输尿管上段肿瘤1例，双侧上尿路同时或先后发生肿瘤2例（1例为双侧输尿管肿瘤，1例为右侧输尿管肿瘤合并左侧肾盂肿瘤）。9例中，男性1例，女性8例。左侧肾盂和输尿管肿瘤采用经腹膜后途径腹腔镜肾脏和输尿管全切联合经尿道电切的方法治疗。右侧上尿路肿瘤采用70。斜卧位经腹腔途径肾脏和输尿管切除并膀胱袖状切除。术后通过膀胱灌注化疗。将钙调磷酸酶类免疫抑制剂转换为西罗莫司。结果9例手术（包括2例双侧手术）均获得成功，术后病理检查结果均证实为尿路上皮癌。随访6个月至4年，未发现切口肿瘤种植转移。1例术后8个月死于尿路上皮癌肺转移，1例术后7个月发生乳腺癌，其他7例目前无瘤存活，肾功能均正常。结论腹腔镜手术治疗肾移植术后自体尿路上皮癌效果较好，具有创伤小、恢复快等优点。左侧和右侧肿瘤应采用不同的手术方法。Objective To investigate the clinical outcome of laparoscopic nephroureterectomy （LUNT） for native upper tract urothelial carcinoma （UC） in renal transplant （RT） recipients. Methods We conducted a retrospective analysis on 1130 RT recipients, and 9 patients （0. 8%, 9/1130） with native upper tract UC were identified. UC was confirmed pathologically in the 9 patients, including 3 cases of unilateral ureter tumor （2 on the right, and 1 on the left）, 4 cases of unilateral renal pelvis tumor （2 on the right, 2 on the left）, 1 case of bilateral ureter tumor and I case of tumor in the right ureter and left kidney. Females predominated （8/9） in the 9 patients with upper tract UC. The patients with left upper urinary tract cancer underwent LUNT using a retroperitoneal approach with a technique of transurethral circumcision of the ureteral orifice. The patients with right upper urinary tract cancer were subjected to nephroureterctomy with ureterectomy and bladder cuff excision by complete laparascopy through a transperitoneal approach. Immunosuppressive protocol conversion from calcineurin inhibitors to sirolimus was performed on all cases. Results In the 9 patients, 11 LUNTs were performed successfully without conversion to open surgery. The follow-up period was from 6 to 48 months. One patient died of lung metastasis at 8th month after tumor excision, and 1 patient disp!ayed ductal cancer of the left breast at 7th month after LNUT. Another seven patients showed no evidence of disease during the follow-up period with normal renal function. Conclusion Our present clinical experience suggested that LNUT for the native upper tract cancer in renal transplant recipients is feasible, safe, and effective.

关 键 词：肾移植 泌尿系肿瘤 腹腔镜检查 

分 类 号：R737.1[医药卫生—肿瘤]