经皮保留肾脏手术治疗上尿路尿路上皮癌11例报告  

Percutaneous Kidney-sparing Surgery for Upper Tract Urothelial Carcinoma: Report of 11 Cases

作　　者：唐世英[1] 肖若陶 郝一昌[1] 邱敏[1] 肖春雷[1] 张树栋[1] Tang Shiying;Xiao Ruotao;Hao Yichang(Department of Urology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院泌尿外科,北京100191

出　　处：《中国微创外科杂志》2024年第12期809-814,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经皮保留肾脏手术(percutaneous kidney-sparing surgery,PCKSS)治疗上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)的效果。方法2018年1月~2023年12月我们对11例UTUC行PCKSS,在常规建立经皮肾工作通道后,经肾镜置入激光光纤或者等离子电切装置,沿肿瘤边缘0.5 cm将肿瘤逐块切除。结果11例PCKSS均顺利完成,3例为多发肿瘤。手术时间75~216 min,中位数150 min。术中出血量20~400 ml,中位数150 ml。术后病理诊断:9例高级别UTUC,其中G23例,G36例,pTa期5例,pT1期4例;2例术前输尿管镜活检病理为pTa期高级别UTUC,PCKSS术中因取材表浅,组织烧灼明显,未见确切癌。术后住院时间(6.9±2.6)d。11例随访2~55个月,中位数12个月,复发4例,其中死亡2例,无复发生存7例。结论PCKSS治疗肾功能不全的UTUC具有一定的应用价值,但术前需要谨慎选择合适的患者,术后严格定期随访。Objective To analyze the clinical efficacy of percutaneous kidney-sparing surgery(PCKSS)for the treatment of upper tract urothelial carcinoma(UTUC).Methods A retrospective analysis was conducted on clinical data and oncological characteristics of 11 cases of UTUC treated with PCKSS at our hospital from January 2018 to December 2023.After establishing a percutaneous renal working channel,a laser fiber or plasma resection device was inserted through the nephroscope to remove the tumor piece by piece along the edge of the tumor by 0.5 cm.Results All the 11 cases of PCKSS surgery were successfully completed,with 3 cases having multiple tumors.The surgical time was 75-216 min(median,150 min),and the intraoperative bleeding volume was 20-400 ml(median,150 ml).Postoperative pathological diagnosis showed 9 cases of high-grade UTUC,including 3 cases of G2 grade and 6 cases of G3 grade,with 5 cases in pTa phase and 4 cases in pT1 phase.In 2 cases with preoperative ureteroscopic biopsy showing high-grade pTa phase UTUC,no definite tumor was found during the PCKSS due to shallow sampling and obvious tissue burning.The average postoperative hospitalization time was(6.9±2.6)d.The 11 cases were followed up for 2-55 months(median,12 months),and there were 4 cases of recurrence,including 2 deaths,and 7 cases of recurrence free survival.Conclusions PCKSS has certain application value for treating UTUC with renal insufficiency.However,it is necessary to carefully select suitable patients before surgery,and strict and regular follow-up is required after surgery.

关 键 词：经皮保留肾脏手术 上尿路尿路上皮癌 

分 类 号：R737.1[医药卫生—肿瘤]