输尿管软镜下钬激光切除术治疗肾盂癌6例报道及文献复习  

Transurethral flexible ureteroscopic holmium laser resection for tumors of renal pelvis: 6 cases report and literature review

作　　者：郝一昌[1] 陈昆[2] 刘余庆[1] 卢剑[1] 肖春雷[1] 马潞林[1] HAO Yi-ehang;CHEN Kun;LIU Yu-qing;LU Jian;XIAO Chun-lei;MA Lu-lin(Department of Urology,Peking University Third Hospital,Beijing 100191,China;Department of Urology,People＇s Hospital of Zhengzhou,Zhengzhou 450003,China)

机构地区：[1]北京大学第三医院泌尿外科,北京100191 [2]郑州人民医院泌尿外科,郑州450003

出　　处：《北京大学学报（医学版）》2018年第5期816-821,共6页Journal of Peking University:Health Sciences

摘　　要：目的:探讨输尿管软镜钬激光切除术治疗肾盂癌的应用价值,并总结治疗过程中的相关经验。方法:回顾性分析北京大学第三医院2015年1月至2017年1月输尿管软镜治疗6例肾盂癌患者的临床资料,手术均由同一名医师操作。患者于全身麻醉下行输尿管软镜钬激光肾盂肿瘤切除术,采用200μm钬激光传导光纤,设置功率为0.5~1.5 J,10~20 Hz,能量10~30 W。采用窄带成像技术寻找肿瘤,并检查切除是否满意。术后4~6周常规行二次输尿管软镜探查,对可疑病变部位行汽化烧灼。术后每6个月行输尿管软镜复查,同时行彩色多普勒超声、CT尿路造影(computed tomography urography,CTU)或磁共振水成像(magnetic resonance urography,MRU)检查,复查手术前连续3天每天进行尿液细胞学检查,检测尿路上皮肿瘤标记物[如尿液核基质蛋白22(nuclear matrix protein22,NMP22)]。术后组织病理为高危尿路上皮癌且肾功能正常的患者,给予全身辅助化疗6个周期。结果:6例患者均顺利完成手术,手术时间45~115 min,平均77.5 min,失血量5~20 m L,术后住院2~5 d,平均3 d,术后随访13~34个月,平均22个月,2例肿瘤复发。例5和例6两患者术后行全身辅助化疗,例5患者的组织病理为高级别尿路上皮癌,术后给予6个周期的全身化疗,化疗期间(术后4个月)患者出现局部复发,再次手术后1年未见复发;例6患者组织病理为低级别尿路上皮癌,但右肾上盏、下盏多发肿瘤,术后予6个周期的全身化疗,随访13个月未见复发。结论:输尿管软镜钬激光切除术治疗肾盂癌的手术技术相对安全,适合孤立肾、肾功能不全等特殊病例以及低危的尿路上皮肿瘤患者,但其复发率较高,需严格掌握适应证。选择行内镜下切除术的高危尿路上皮癌患者,术后应积极予吉西他滨与顺铂(gemcitabine and cisplatin,GC)方案的全身辅助化疗,采用内镜治疗和全身辅助化疗联合的方法提高尿路上皮癌�Objective： To summarize the experience of flexible ureteroscopic holmium laser resection in treatment of renal pelvic carcinoma and to evaluate its value in treatment of renal pelvic carcinoma.Methods： The clinical data of 6 patients with renal pelvic carcinoma treated in Peking University Third Hospital from January 2015 to January 2017 were retrospectively analyzed. The 6 patients were treated by the same experienced urologist and by flexible ureteroscopic holmium laser resection of renal pelvic tumors under general anesthesia. Regarding the intensity of the holmium laser,10-30 W was generally used with settings of 0. 5-1. 5 J and 10-20 Hz. In general,a 200 μm end-firing holmium laser fiber was used. Narrow-band imaging （NBI） technique was applicated to search for tumors and check whether the excision was satisfactory. Routine ＂second flexible ureteroscopy＂was performed after 4-6 weeks,and suspected lesions were referred for a biopy,then vaporized and cauterized. The ureteroscopy was examined every 6 months after operation,and color Doppler ultrasound,computed tomography urography （CTU） or magnetic resonance urography （MRU） were performed at the same time. The urine tumor cells were examined for 3 days before the operation,and the urine tumor markers,such as urinary nuclear matrix protein 22 （NMP22） were tested. For cases with high-risk urothelial carcinoma and normal renal function,and 6 cycles of systemic adjuvant chemotherapy were performed after operation. Results： All of the cases were successfully treated. The data were as follows： the operation time 77. 5 min （45-115 min）,the blood loss 10 m L （5-20 m L）,and hospital stay after surgery 3 days （2-5 days）. After13-34 months＇ follow-up,two patients had recurrent tumor recurrence and underwent resection operation. Two patients received systemic adjuvant chemotherapy after operation. Case 5 was histopathologically high grade urothelial carcinoma,and 6 cycles of systemic chemotherapy were given after operation. Local

关 键 词：输尿管镜检查 钬激光 肾盂癌 

分 类 号：R737.11[医药卫生—肿瘤]