大通道经皮肾盂肿瘤电切术治疗孤立肾肾盂肿瘤2例报告  

Percutaneous Resection of Renal Pelvic Neoplasms in Isolated Kidney through a Large Sheath:Report of Two Cases

作　　者：关升[1] 唐喆[1] 孙卫兵[1] 田洪雨[1] 王艳龙[2] 黄灶明[3] 杨玻[1] 钱宗鸣[1] 

机构地区：[1]大连医科大学附属第二医院泌尿外科,大连116023 [2]大连市中心医院泌尿外科,大连116033 [3]第三军医大学附属大坪医院泌尿外科,重庆400042

出　　处：《中国微创外科杂志》2012年第6期565-568,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：2011年3～7月对2例孤立肾肾盂肿瘤行大通道经皮肾盂肿瘤电切术。1例术后复查CT见肾盂中部不规则组织密度影,考虑肿瘤部分残留,16 d后再次全麻下行经皮右肾盂肿瘤电切术,术中见大小1.0 cm×1.0 cm肿瘤残留,二次电切,留置引流管同前。病理结果:纤维结缔组织,其中脉管组织呈瘤样增生改变。另1例手术时间85 min,术中出血约50ml,术后3 d复查CT,未见明显肿瘤残余组织。病理结果:符合低级别浸润性尿路上皮癌,浸润黏膜固有层。术后2周膀胱灌注卡介苗120 mg+生理盐水至100 ml臀高头低位灌注,通过输尿管内双J管返流肾盂内灌注治疗,每周1次持续6次。2例术后随访3个月,复查CT未见肿瘤复发。我们认为大通道经皮肾盂肿瘤电切治疗孤立肾肾盂肿瘤安全有效,尤其适用于有根治性肾输尿管切除术手术禁忌证的肾盂癌。Since March to July 2011, we performed percutaneous resection of renal pelvic neoplasm on two patients with isolated kidney. In one of the cases, postoperative CT scan revealed residual right renal pelvic tumor, therefore, a second operation was carried out in 16 days under general anesthesia. During the second procedure, we found a residual tumor sized 1.0 cm x 1.0 cm. After the operation, a drainage tube was placed as that after the first operation. Postoperative pathological examination showed fibrous connective tissue with tumor-like vascular tissue proliferation. In the other patient, the operation was completed in 85 min, and the intraoperative blood loss was around 50 ml. Postoperative CT scan in 3 days showed no residual tumor tissues. Pathological examination confirmed urinary tract transitional cell carcinoma （G1） infiltrating the lamina propria. Two weeks after the operation, with the head lower than the bottom, the patient received bladder irrigation of BCG （ 120 mg） plus NS （ 100 ml）, as well as intrapelvic irrigation with a double-J tube through the ureter （once a week for six weeks）. Both the patients were followed up for three months, during which reexamination by CT scan showed no recurrent tumors. We believe that percutaneous resection of renal pelvic neoplasm via a large sheath is safe and effective. It is an alternative approach, especially for patients with contradictions for nephroureterectomy.

关 键 词：肾盂肿瘤 孤立肾 大通道 

分 类 号：R737.11[医药卫生—肿瘤]