改良四孔法完全腹腔镜下移植肾同侧自体上尿路肿瘤根治术的临床观察  

The clinical study of modified four-hole complete laparoscopy with ipsilateral autogenous upper urinary tract tumor transplantation

作　　者：纪阿林 吕佳[1] 祁小龙[1] 张大宏[1] Ji Alin

机构地区：[1]浙江省人民医院,310014

出　　处：《浙江临床医学》2021年第8期1129-1131,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨改良四孔法完全腹腔镜下移植号同侧自体上尿路肿瘤根洽术的可行性及临床疗效。方法回顾性分析2012年1月至2018年12月本院9例肾移植术后移植肾同侧自身上尿路肿瘤患者的临床资料,9例患者均行改良四孔法完全腹腔镜下移植肾同侧原肾、输尿管切除及膀胱袖状切除术,并经下腹部正中小切口完整取出肾输尿管全长标本。记录并分析所有患者手术期间及术后的相关临床指标。结果本组9例手术均顺利,无1例转开放,平均手术时间1.5 h,术中平均出血量约为156mL,1~2天恢复排气,无术中、术后并发症,术后血红蛋白及血清肌酐水平无明显变化,住院时间平均7.3天。术后病理结果显示,9例患者均为尿路上皮癌,所有手术标本的切缘均呈阴性。中位随访时间为52个月。1例因再发移植肾对侧自体肾盂癌行对侧肾输尿管全长切除术,后因2次发现膀胱肿瘤行尿道膀胱肿瘤电切术,术后未见肿瘤复发;余8例患者术后随访期间未出现肿瘤复发或转移。结论改良四孔法完全腹腔镜下进行肾、输尿管及膀胱袖状切除以治疗移植号同侧自体上尿路肿瘤,可巧妙避开手术中移植肾和移植输尿管的解剖位置,具有手术时间短、术中出血少、术后恢复快等优点,是一项可行微创手段,且操作简单易掌握。Objective To explore the feasibility and efficacy of a novel technique of laparoscopic native kidney nephroureterectomy for upper tract urothelial carcinoma in patients who had ipsilateral renal transplantation.Methods In this retrospective analysis,from January 2012 to December 2018,nine renal transplant patients had upper tract urothelial carcinoma on the same side of transplant kidney.All nine patients received laparoscopic resection of the ipsilateral native kidney,ureter and bladder cuff excision.The specimen was retrieved through lower abdomen midline incision.Penoperative clinical data was collected and analyzed.Results All surgeries were completed laparoscopically with no conversion to open.The average operation time was 1.5 hours,and the average intraoperative blood loss was 156 mL.Bowel movement was restored in 1 to 2 days.There were no intraoperative or postoperative complications,no significant changes in hemoglobin and serum creatinine.The average length of hospital stay was 7.3 days.Histopathology showed all 9 patients had urothelial carcinoma.The margins of all surgical specimens were negative.Patients were followed up for an average of 52 months.One patient had urothelial carcinoma in the renal pelvis of contralateral native kidney and received another neohroureterectomy.The same patient had two recurrence in bladder which required transurethral resection of bladder tumor.The other eight patients had no recurrence or metastasis during the followup.Conclusion This modified technique of laparoscopic nephroureterectomy and bladder cuff excision on the same side of the groin transplant kidney successfully spares the renal graft and its ureter.Compared with conventional technique,it has the advantage of reduced operation time,less intraoperative blood loss and rapid postoperative recovery.It is a feasible minimally invasive approach to replace the traditional open,or retroperitoneal surgery for the same patient population.

关 键 词：移植肾 腹腔镜 改良四孔法 上尿路肿瘤 

分 类 号：R73[医药卫生—肿瘤]