经脐单孔腹腔镜联合经尿道途径辅助单侧肾输尿管全长逆行切除术的可行性及安全性分析  

Application of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy

作　　者：邓仲磊[1] 苏学林 苏健[1] 沈露明[1] 张扬[1] 袁琳[1] 王宁红[1] 徐国江[1] 周萍[1] 朱清毅[1] Deng Zhonglei;Su Xuelin;Su Jian;Shen Luming;Zhang Yang;Yuan Lin;Wang Ninghong;Xu Guojiang;Zhou Ping;Zhu Qingyi(Department of Urology,Jiangsu Provincial Hospital of Traditional Chinese Medicine,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing 210029,China)

机构地区：[1]江苏省中医院南京中医药大学附属医院泌尿外科,210029

出　　处：《中华泌尿外科杂志》2020年第11期820-824,共5页Chinese Journal of Urology

摘　　要：目的探讨经脐单孔腹腔镜联合经尿道途径辅助单侧肾输尿管全长逆行切除术在上尿路尿路上皮癌治疗中的可行性、安全性。方法回顾性分析南京中医药大学附属医院2018年1月至2019年11月采用自制尿道辅助通道行经脐单孔腹腔镜联合经尿道途径辅助单侧肾输尿管全长逆行切除术治疗的12例患者的临床资料。男7例,女5例;年龄50~78岁,平均65.9岁;左侧病变8例(左输尿管肿瘤2例,左肾盂肿瘤6例),右侧病变4例(右输尿管肿瘤2例,右肾盂肿瘤2例)。手术方法:术中经腹途径游离并夹闭输尿管下段后,采用1470激光袖状切除输尿管膀胱壁内段,在斑马导丝引导下置入尿道辅助通道及辅助器械,逆行辅助操作完成手术。记录手术时间、术中出血量、术中是否增加辅助套管、术后住院时间、术后引流管拔除时间、术中和术后并发症、术后病理等。结果12例手术均顺利完成。手术时间135~260 min,平均194 min;术中出血量25~100 ml,平均50 ml;术后住院时间5~24 d,平均11.6 d。12例中8例术后留置腹腔引流管,留置时间3~11 d,平均6.8 d。12例中1例术中增加辅助套管。术中、术后无患者接受输血治疗,术后病理切缘均阴性。术后1例膀胱吻合口漏尿,延长尿管留置时间后自愈,术后3周拔除尿管;12例无术后切口感染,无发热、出血、静脉血栓形成等手术相关并发症。12例中位随访时间12个月(5~15个月),1例因腰椎转移于术后8个月死亡,余患者未出现肿瘤局部复发或远处转移。结论经脐单孔腹腔镜联合经尿道途径辅助单侧肾输尿管全长逆行切除术创伤小、出血少,术后恢复快,且激光直视下能准确切除输尿管开口,手术安全、有效。Objective To investigate the feasibility and safety of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy in the treatment of upper urinary tract epithelial carcinoma.Methods The clinical data of 12 patients from January 2018 to November 2019 with unilateral retrograde nephroureterectomy were analyzed retrospectively.There were 7 males and 5 females with an average age of 65.9 years,the age ranged from 50 to 78 years.There were 8 cases with left ureteral tumor,6 cases with left renal pelvis tumor,4 cases with right tumor(2 cases of right ureteral tumor and 2 cases of right renal pelvis tumor).Surgical methods:1470 laser sleeve was used to remove the inner segment of the ureter bladder wall after the lower ureter was clipped through abdominal approach,and the urethra was inserted under the guidance of zebra guide wire.The operation time,intraoperative blood loss,intraoperative auxiliary cannula,postoperative hospital stay,postoperative drainage tube removal time,intraoperative and postoperative complications,postoperative pathology were recorded.Results All of the operations were successful.The mean operation time was 194(135-260)min,the mean estimated blood loss was 50(25-100)ml,and the mean hospitalization time was 11.6(5-24)d.Among the 12 patients,8 patients had abdominal drainage tube after operation.The mean time for drainage was 6.8(3-11)d.One patient added a 5 mm ancillary port.One patient had urinary leakage at the bladder anastomotic site,the catheter was removed 3 weeks later.The other patients had no postoperative incision infection,fever,bleeding,venous thrombosis and other related complications.No patient received blood transfusion and the pathological margin was negative.The median follow-up time was 12 months(5-15 months).One patient died of lumbar metastasis 8 months after operation,and others were neither tumor recurrence nor distant metastasis.Conclusions The application of laparoendoscopic single-site combined with transurethral approac

关 键 词：癌 上尿路 单孔腹腔镜 肾输尿管全长切除术 经尿道途径辅助 

分 类 号：R737.1[医药卫生—肿瘤]