腹腔镜及开放根治性肾输尿管膀胱切除术治疗输尿管癌合并膀胱混合癌1例报告及文献回顾分析

目的：探讨腹腔镜和开放根治性肾输尿管膀胱切除术治疗输尿管癌合并膀胱混合癌患者的可行性和安全性。方法：回顾分析1例单侧输尿管癌并浸润性膀胱混合癌，腹腔镜下行根治性肾输尿管膀胱切除术及开放尿流改道手术患者的临床资料并进行随访分析。结果：术前经B超、CT、膀胱镜、输尿管镜和静脉肾盂造影等检查证实为左输尿管癌并浸润性多发膀胱癌，行腹腔镜肾输尿管膀胱切除术及开放尿道切除术和右侧输尿管皮肤造口术，手术时间480min，术中出血量约560ml，无输血。术后肠功能恢复时间为3d，下床活动时间4d。术后未出现并发症。术后病理结果为膀胱高级别泌尿上皮癌伴浸润性鳞状细胞癌侵及全层。左输尿管癌高级别泌尿上皮癌侵及全层。输尿管癌分期分级为T2N0M0，膀胱癌为T2N0M0。术后随访10月，患者无瘤生存至今。结论：单侧输尿管癌合并膀胱混合癌可行一期根治性肾输尿管膀胱切除术，腹腔镜下行该手术是可行及安全的。较开放手术创伤小，恢复快。膀胱混合癌很难早期确诊，为了使膀胱混合癌得到早期诊断和治疗，提高患者生存率，行膀胱镜检查时，应多位点取材。

Radical nephroureterectomy and cystectomy for ureteral tumor and bladder mixed tumor by laparoscopic combined open surgery

Objective ： To evaluate the safety and availability of laparoscopic and open radical nephroureterocystec-tomy to the patients with tumors of ureteral tumor complicating with bladder cancer. Methods： Followed up 1 patient who had been performed radical nephroureterocytectomy due to the tumors of unilateral ureteral tumor complicating with invasive bladder cancer. Results： The patient was diagnosed as tumor of unilateral ureter complicating with inva-sive bladder cancer by cystoscope, ureteroscope, ultrasound, intraveneous pyelography and CT. The patient with left ureteral cancer complicating with bladder cancer was performed the operation of laparoscopy radical nephroureterocys-tectomy and open urethral resection and ureterostomy. The total operation time was 480min and bleeding volume was 560 ml without blood transfusion. The recovery time of alimentary tract and the time of free activity were 3 days and 4 days. No obvious complications were observed. Postoperative pathological results showed that the slide were urothe-lial tumors with tumor stage of ureteral cancer T2NoM0 and tumor stage of bladder cancer T2N0M0 complicated by squamous cell carcinoma. The time of follow-up was 10 months without recurrence. Conclusion： Nephroureterocys-tectomy is available to tumor of unilateral ureteral tumor complicating with bladder mixed cancer. The operation under laparoscopy is available and safe, with less trauma and bleeding and faster recovery. Early diagnosis of bladder mixed tumor is difficult. For early diagnosis and treatment of bladder cancer and improve patient survival rates, multiple sites should be drawn when we perform cystoscopy.