高危肾盂癌患者的简化手术治疗

目的:探讨高危肾盂癌患者的治疗方法。方法:自2009年7月~2012年12月对14例高龄且伴有严重并发症的肾盂癌患者行经腹膜后途径腹腔镜下肾脏+中上段输尿管切除术,术后正规膀胱灌注表柔比星注射液,以预防再发膀胱癌,并定期进行影像学及膀胱镜检查。结果:14例手术全部成功,手术时间63~105min,平均78.3min。术后24~48小时恢复饮食,5~9天出院。术后病理检查2例为鳞状细胞癌,12例为尿路上皮细胞癌;其中2例为浸润性肾盂癌伴肾门处淋巴结转移。术后13例得到随访,1例失访;随访8~36个月,平均21.4个月。1例术后13个月死于肺部转移,2例术后21个月因心肺疾病死亡;2例术后再发膀胱癌,行根治性全膀胱切除。结论:对于高危肾盂癌患者,简化手术,腹腔镜下切除肾脏+中上段输尿管,术后配合正规膀胱灌注化疗是一种有效安全的治疗方法。

Simplify surgical treatment for high-risk patients with renal pelvis cancer

Objective： To explore a suitable surgical treatment for high-risk patients with renal pelvis cancer. Method.. Fourteen senior patients with renal pelvis carcinoma combined with serious complications underwent kidney and upper ureter resection via retroperitoneal laparoscopic approach. Postoperative intravesical instillation of epirubicin was given regularly to prevent the recurrence of bladder cancer and regular imaging and cystoscopy were also taken. Result： Surgeries were successful in all 14 cases. The operation time was 63-105 （average, 78. 3） min. Recovery of postoperative oral food intake time was 24-48 h and postoperative hospital stay was 5-9 d. Pathological examination showed two cases were found squamous cell carcinoma and 12 cases were found urothelial cell carcinoma including two cases of invasive carcinoma with renal hilum lymph node metastases. All cases except one were followed up for 8-36 （average, 21.4） months. One patient died of lung metastasis 13 months postoperatively and two patients died due to heart and lung disease. Two cases of recurrent bladder cancer underwent open radical cysteetomies. Conclusion： Laparoscopic kidney and upper ureteral resection and postoperative intravesical chemotherapy is an effective method of treatment for high-risk patients with renal pelvis cancer.