截断式输尿管末端切除治疗输尿管口周围肿瘤  

Truncated terminalureterectomy in the treatment of peri-ureteral orifice bladder tumors

作　　者：高永涛[1] 陈文政[2] 陈光富[2] 符伟军[2] 祖强[2] 孙圣坤[2] 张旭[2] GAO Yongtao;CHEN Wenzheng;CHEN Guangfu;FU Weijun;ZU Qiang;SUN Shengkun;ZHANG Xu(Department of Urology,Weifang Hospital of Traditional Chinese Medicine,Weifang 261041,China;不详)

机构地区：[1]山东省潍坊市中医院泌尿外一科,261041 [2]中国人民解放军总医院泌尿外科医学部

出　　处：《现代泌尿生殖肿瘤杂志》2023年第2期80-83,共4页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的 探讨经尿道切除输尿管口周围膀胱肿瘤的有效方法。方法回顾性分析2021年1月至2021年10月期间中国人民解放军总医院泌尿外科医学部收治的15例接受截断式输尿管末端切除术患者的临床资料。所有肿瘤边缘距离输尿管口均在0.5 cm以内。所有患者均行β刀截断式输尿管末端切除术,术后定期随访。统计并分析手术时间、出血量、闭孔神经反射发生率、膀胱肿瘤复发、肾积水情况等。结果 15例患者均顺利完成手术,手术时间10~32 min,平均(21.1±6.2)min,均未发生闭孔神经反射及围手术期出血。患者术后均留置6F输尿管支架管,术后1个月应用膀胱镜拔出。术后病理均为非肌层浸润性尿路上皮癌,其中低级别12例、高级别3例,肿瘤基底部及切缘均为阴性。患者均接受6~15个月的随访,平均(10.7±3.3)个月,未见上尿路积水和输尿管、肾盂肿瘤及膀胱肿瘤复发。结论 截断式输尿管末端切除术治疗输尿管口周围膀胱肿瘤具有手术解剖清晰、切除范围精准、并发症少的特点,在彻底切除肿瘤的基础上能够保留输尿管膀胱壁内段的形态和功能,是治疗输尿管口周围膀胱肿瘤安全、有效的新术式。Objective To evaluate a reliable method to treat the peri-ureteral orifice bladder tumor.Methods Clinical data of 15 patients with peri-ureteral bladder tumor who received truncated terminal ureterectomy(TTU)were reviewed from January 2021 to October 2021.The distance between the tumor border and the ureteral orifice was less than 0.5 cm in all patients.All patients underwentβelectrode assisted TTU and were followed up regularly.The operation time,the volume of bleeding,the incidence of obturator nerve reflex,bladder tumor recurrence and the incidence of hydronephrosis were analyzed.Results Fifteen patients received transurethral TTU underβelectrode.The average operation time was(21.1±6.2)min(range 10-32 min).No obvious obturator nerve reflex or perioperative bleeding occurred in all cases.All patients were retained 6F ureteral stents which were removed by cystoscopy 1 month postoperatively.Postoperative pathology all showed non-muscle-invasive urothelial carcinoma,including 12 cases of low grade and 3 cases of high grade.The tumor base and border were clear.The average post operative follow-up time was(10.7±3.3)months(range 6-15 months).No cases were found hydronephrosis or tumor recurrence in ureter,rend pelvis or bladder.Conclusions TTU is a novel method in the treatment of peri-ureteral orifice bladder tumors.Advantages include clear anatomy,precise tumor resection,and fewer complications.TTU proved to be a safe and effective surgical method for resection of peri-ureteral orifice non-muscle-invasive bladder tumors,for it can achieve a thorough tumor resection while preserving the intramural segment of the ureter at the same time.

关 键 词：膀胱肿瘤 输尿管口 输尿管壁内段 β刀 

分 类 号：R737.14[医药卫生—肿瘤]