预防肾盂输尿管癌术后再发膀胱癌的手术方法研究

目的探讨预防。肾盂输尿管癌术后再发膀胱癌的手术方法。方法对156例单纯。肾盂癌、单纯输尿管癌中获随访的139例患者资料进行同顾性总结。肾盂癌78例。输尿管癌61例。肿瘤细胞分级：G1 19例，G2 88例，G3 32例。肿瘤分期：Ta—T1 38例，T2 80例，T3～T4 21例。肿瘤直径0．8—6．0cm。结果139例均行根治性。肾、输尿管及管口周围部分膀胱壁（1．5—2．0cm）切除术。术后随访1～10年。再发膀胱癌55例，占39．6％。肾盂癌术中先用纱条结扎输尿管后游离切除患肾输尿管及管口周围部分膀胱者术后膀胱癌再发率18．5％（5／27），未先结扎输尿管者再发率27．5％（14／51）。术后当日膀胱灌注化疗者膀胱癌再发率32．3％（10／31）。术后3周开始膀胱灌注化疗者膀胱癌再发率34．9％（30／86）。术后当日及术后序贯膀胱灌注化疗者术后膀胱癌再发率20．0％（4／20），单纯术后序贯膀胱灌注化疗者膀胱癌再发率39．3％（26／66）。2者比较差异有统计学意义（P〈0．01）。结论术后当日及术后序贯膀胱灌注化疗可有效降低。肾盂输尿管癌术后膀胱癌的再发率，游离切除。肾输尿管前先结扎输尿管对预防肾盂癌术后再发膀胱癌可能有益。     

肾盂输尿管癌术后再发尿路上皮癌

１９７８年１月～１９９２年１２月收治肾盂输尿管癌８５例，术后再发尿路上皮癌２６例。肾输尿管膀胱袖状切除术后再发率（３０．１％）低于肾输尿管全切除术（５４．５％）和肾切除术（７５％）。病侧管口处膀胱癌再发率高。同时发生多部位癌、低级低期者术后再发率高，再发时间多在术后３年以内。术后再发与非再发者５年生存率无显著性差异（Ｐ＞０．０１）。对其再发因素早期发现与预后进行讨论。     

肾盂输尿管移行上皮癌术后再发膀胱癌多因素分析

目的防止肾盂输尿管癌术后再发膀胱癌。方法采用回顾性研究对获随访８５例进行总结。结果术后膀胱癌再发率３８％（３２／８５）。吸烟指数＞５００者为５４％（１８／３３），高于不吸烟或吸烟指数＜５００者的２７％（１４／５２），Ｐ＜０．０１。未切除患侧输尿管口周围膀胱壁的再发率为４５％（１０／２２），高于肾输尿管膀胱部分切除术的２０％（９／４５），Ｐ＜０．０５。Ⅱ～Ⅲ级，Ｔ１～Ｔ２，ＣｅｒｂＢ２阳性表达者再发率高，术后灌注化疗２年后再发率５％（２／３９），低于未灌注者的２２％（１０／４６），Ｐ＜０．０５。结论吸烟是术后再发危险因素，切除输尿管口周围部分膀胱壁是防止再发的关键，术后灌注化疗防止远期再发效果好。     

肾盂输尿管癌术后膀胱灌注化疗对复发膀胱癌的影响

目的 探讨肾盂输尿管癌术后膀胱灌注化疗对膀胱复发癌的影响.方法 对96 例获随访的原发性肾盂输尿管癌患者的临床资料进行回顾性研究总结.结果 行肾盂输尿管膀胱部分切除术术后未进行膀胱灌注化疗的患者膀胱癌复发率为34.4%(11/32),术后行膀胱灌注化疗者膀胱癌复发率为18.8%(12/64),差异有显著性意义(pO.05).术中先行输尿管末端结扎者术后膀胱癌复发率较未采取结扎措施者低,但两者相比未见统计学意义(P>O.05).结论 肾盂输尿管癌行肾输尿管膀胱酃分切除术后预防性膀胱灌注化疗可有效降低复发件膀胱癌的发生率.术中游离肾输尿管前行输尿管末端结扎并同时行预防性膀胱灌注化疗对预防肾盂输尿管癌术后再发膀胱癌可能有效.     

肾盂输尿管癌术后膀胱灌注化疗对复发膀胱癌的影响

目的 探讨肾盂输尿管癌术后膀胱灌注化疗对膀胱复发癌的影响.方法 对96 例获随访的原发性肾盂输尿管癌患者的临床资料进行回顾性研究总结.结果 行肾盂输尿管膀胱部分切除术术后未进行膀胱灌注化疗的患者膀胱癌复发率为34.4%(11/32),术后行膀胱灌注化疗者膀胱癌复发率为18.8%(12/64),差异有显著性意义(pO.05).术中先行输尿管末端结扎者术后膀胱癌复发率较未采取结扎措施者低,但两者相比未见统计学意义(P>O.05).结论 肾盂输尿管癌行肾输尿管膀胱酃分切除术后预防性膀胱灌注化疗可有效降低复发件膀胱癌的发生率.术中游离肾输尿管前行输尿管末端结扎并同时行预防性膀胱灌注化疗对预防肾盂输尿管癌术后再发膀胱癌可能有效.     

肾盂输尿管癌术后膀胱灌注化疗对复发膀胱癌的影响

目的 探讨肾盂输尿管癌术后膀胱灌注化疗对膀胱复发癌的影响.方法 对96 例获随访的原发性肾盂输尿管癌患者的临床资料进行回顾性研究总结.结果 行肾盂输尿管膀胱部分切除术术后未进行膀胱灌注化疗的患者膀胱癌复发率为34.4%(11/32),术后行膀胱灌注化疗者膀胱癌复发率为18.8%(12/64),差异有显著性意义(pO.05).术中先行输尿管末端结扎者术后膀胱癌复发率较未采取结扎措施者低,但两者相比未见统计学意义(P>O.05).结论 肾盂输尿管癌行肾输尿管膀胱酃分切除术后预防性膀胱灌注化疗可有效降低复发件膀胱癌的发生率.术中游离肾输尿管前行输尿管末端结扎并同时行预防性膀胱灌注化疗对预防肾盂输尿管癌术后再发膀胱癌可能有效.     

肾盂输尿管癌术后膀胱灌注化疗对复发膀胱癌的影响

目的 探讨肾盂输尿管癌术后膀胱灌注化疗对膀胱复发癌的影响.方法 对96 例获随访的原发性肾盂输尿管癌患者的临床资料进行回顾性研究总结.结果 行肾盂输尿管膀胱部分切除术术后未进行膀胱灌注化疗的患者膀胱癌复发率为34.4%(11/32),术后行膀胱灌注化疗者膀胱癌复发率为18.8%(12/64),差异有显著性意义(pO.05).术中先行输尿管末端结扎者术后膀胱癌复发率较未采取结扎措施者低,但两者相比未见统计学意义(P>O.05).结论 肾盂输尿管癌行肾输尿管膀胱酃分切除术后预防性膀胱灌注化疗可有效降低复发件膀胱癌的发生率.术中游离肾输尿管前行输尿管末端结扎并同时行预防性膀胱灌注化疗对预防肾盂输尿管癌术后再发膀胱癌可能有效.     

肾盂输尿管癌术后膀胱灌注化疗对复发膀胱癌的影响

目的 探讨肾盂输尿管癌术后膀胱灌注化疗对膀胱复发癌的影响.方法 对96 例获随访的原发性肾盂输尿管癌患者的临床资料进行回顾性研究总结.结果 行肾盂输尿管膀胱部分切除术术后未进行膀胱灌注化疗的患者膀胱癌复发率为34.4%(11/32),术后行膀胱灌注化疗者膀胱癌复发率为18.8%(12/64),差异有显著性意义(pO.05).术中先行输尿管末端结扎者术后膀胱癌复发率较未采取结扎措施者低,但两者相比未见统计学意义(P>O.05).结论 肾盂输尿管癌行肾输尿管膀胱酃分切除术后预防性膀胱灌注化疗可有效降低复发件膀胱癌的发生率.术中游离肾输尿管前行输尿管末端结扎并同时行预防性膀胱灌注化疗对预防肾盂输尿管癌术后再发膀胱癌可能有效.     

肾盂输尿管癌术后膀胱灌注化疗对复发膀胱癌的影响

目的 探讨肾盂输尿管癌术后膀胱灌注化疗对膀胱复发癌的影响.方法 对96 例获随访的原发性肾盂输尿管癌患者的临床资料进行回顾性研究总结.结果 行肾盂输尿管膀胱部分切除术术后未进行膀胱灌注化疗的患者膀胱癌复发率为34.4%(11/32),术后行膀胱灌注化疗者膀胱癌复发率为18.8%(12/64),差异有显著性意义(pO.05).术中先行输尿管末端结扎者术后膀胱癌复发率较未采取结扎措施者低,但两者相比未见统计学意义(P>O.05).结论 肾盂输尿管癌行肾输尿管膀胱酃分切除术后预防性膀胱灌注化疗可有效降低复发件膀胱癌的发生率.术中游离肾输尿管前行输尿管末端结扎并同时行预防性膀胱灌注化疗对预防肾盂输尿管癌术后再发膀胱癌可能有效.     

肾盂输尿管癌术后膀胱灌注化疗对复发膀胱癌的影响

目的 探讨肾盂输尿管癌术后膀胱灌注化疗对膀胱复发癌的影响.方法 对96 例获随访的原发性肾盂输尿管癌患者的临床资料进行回顾性研究总结.结果 行肾盂输尿管膀胱部分切除术术后未进行膀胱灌注化疗的患者膀胱癌复发率为34.4%(11/32),术后行膀胱灌注化疗者膀胱癌复发率为18.8%(12/64),差异有显著性意义(pO.05).术中先行输尿管末端结扎者术后膀胱癌复发率较未采取结扎措施者低,但两者相比未见统计学意义(P>O.05).结论 肾盂输尿管癌行肾输尿管膀胱酃分切除术后预防性膀胱灌注化疗可有效降低复发件膀胱癌的发生率.术中游离肾输尿管前行输尿管末端结扎并同时行预防性膀胱灌注化疗对预防肾盂输尿管癌术后再发膀胱癌可能有效.     

A clinical study of tumor of the renal pelvis and ureter

We report 54 patients with urothelial tumors in upper urinary tract admitted to our hospital between July, 1962 and December, 1985. The patients consisted of 38 males and 16 females; side their ages ranged from 47 to 88 years with a mean of 63.4 years. The affected side was the right side in 21 cases, and the left side in 33 cases. Macro-or microhematuria was observed in 87% of the patients. Pathologically, 53 of the patients had transitional cell carcinoma and 1 had papilloma. Six patients had a past history of bladder tumor. Simultaneous bladder tumor was identified in 10 cases. Vesical recurrence was observed in 5 cases. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 21 cases, and total nephrectomy without bladder cuff resection in 11 patients. The actual five-year survival rate was 53% for all the patients; 52% for patients with renal pelvic tumors, 75% for those with ureteral tumors and 15% for those with renal pelvic and ureteral tumors. The patients who received nephroureterectomy had a postoperative survival rate similar to that of those who received nephroureterectomy with bladder cuff resection. A simultaneous bladder tumor lowered the survival rate.     

后腹腔镜下肾输尿管切除加经尿道膀胱袖状切除治疗上尿路上皮癌

目的 探讨后腹腔镜下肾输尿管切除加经尿道膀胱袖状切除治疗上尿路上皮癌的临床效果.方法 上尿路上皮癌患者82例(肾盂癌69例,输尿管癌13例).男39例,女43例.平均年龄65(37～82)岁.电切镜经尿道膀胱袖状分离输尿管管口及壁内段,后腹腔镜下切除肾、输尿管.观察手术时间、术中出血量、引流管留置时间、尿管留置时间、术后住院日及术后并发症等.随访肿瘤转移与复发情况.结果 82例手术顺利.手术平均时间135(95～210)min.术中平均失血110(60～260)ml.术后引流管平均留置3(2～4)d.尿管平均留置6(5～7)d.术后平均住院7(6～9)d.74例患者获随访平均31(6～76)个月.高级别浸润性癌随访16例,复发转移3例;高级别与低级别非浸润性癌分别随访29例,膀胱内复发5例(高级别3例,低级别2例);切口部位肿瘤转移复发1例.3年随访肿瘤复发率为10.6%(5/47).结果 后腹腔镜下肾输尿管切除加经尿道膀胱袖状切除治疗上尿路上皮癌,输尿管口周围组织及输尿管壁内段切除确切,创伤小、康复快,手术安全易行,疗效可靠.     

腹腔镜肾输尿管全长切除术及膀胱袖状切除术治疗上尿路移行细胞癌

目的:评价腹腔镜经腹腔径路行肾输尿管全长切除术及膀胱袖状切除术治疗上尿路移行细胞癌的有效性及安全性。方法:对6例上尿路移行细胞癌患者行腹腔镜经腹腔径路肾切除术,经同侧下腹斜切口、袖状切除输尿管并完整取出标本。结果:6例手术均获成功,无中转开放手术,手术时间200～320min,平均250min,术中出血100～300ml,均未输血,住院8～12d,平均9d,术后常规膀胱灌注丝裂霉素,随访2～14个月,均无复发或转移。结论:腹腔镜肾输尿管全长切除术是治疗上尿路移行细胞癌安全有效的微创手术,具有痛苦小、康复快等优点。     

后腹腔镜联合尿道电切镜根治性肾输尿管切除治疗上尿路肿瘤3例

目的探讨后腹腔镜联合尿道电切镜根治性肾输尿管切除治疗上尿路移行细胞癌的临床疗效。方法对2例肾盂癌、1例输尿管上段移行细胞癌先采用尿道电切镜行患侧输尿管口膀胱黏膜袖套状切除,而后行后腹腔镜根治性肾输尿管全切术。结果3例手术均获成功,平均手术时间190min,术中出血平均50mL,患者均于术后36~48h下床活动,术后住院时间9~11d(平均10d),术中、术后无严重并发症。结论后腹腔镜联合尿道电切镜根治性肾输尿管切除治疗上尿路肿瘤是一种安全、有效的微创手术方法,实用性较强,具有良好的应用前景。     

低分期上尿路上皮癌根治手术不加膀胱袖状切除的可行性分析

目的 分析低分期肾盂及中上段输尿管尿路上皮癌行根治性肾切除术与经典肾盂癌根治性手术后肿瘤复发率的差异,探讨低分期上尿路上皮癌患者不行膀胱袖状切除的可行性.方法 回顾性分析2000-2007年收治73例上尿路上皮癌患者的资料.男36例,女37例.平均年龄66(45～87)岁.其中肾盂癌46例,中上段输尿管癌27例.根据术式分为经典肾盂癌根治性手术组(35例)和根治性肾切除组(38例).分析2组患者病理及随访结果,比较2组患者术后复发率的差异.结果 经典肾盂癌根治性手术组肿瘤复发8例(22.9%),其中T1患者复发率20.0%(3/15);根治性肾切除组肿瘤复发8例(21.1%),其中T1患者复发率19.0%(4/21),2组总复发率和T1肿瘤复发率差异无统计学意义(P>0.05).经典肾盂癌根治性手术组19例肾盂癌中,肿瘤复发4例(21.1%);16例中上段输尿管癌中,肿瘤复发4例(25.0%),2组肿瘤复发率差异无统计学意义(P>0.05).根治性肾切除组27例肾盂癌中,肿瘤复发3例(11.1%);11例中上段输尿管癌中,肿瘤复发5例(45.5%),2组肿瘤复发率差异有统计学意义(P<0.05).结论 低分期上尿路上皮癌患者可不行膀胱袖状切除术,但肿瘤位于输尿管者应行膀胱袖状切除术.     

后腹腔镜辅助小切口肾输尿管及膀胱袖套状切除术(附7例报告)

目的:探讨后腹腔镜辅助小切口肾输尿管及膀胱袖套状切除术的手术技巧。方法:用后腹腔镜辅助小切口为7例肾盂及输尿管肿瘤患者行肾输尿管及膀胱袖套状切除术,其中肾盂癌4例,输尿管癌3例。结果:7例手术均获成功,手术时间90~120min,平均108min,术中出血50~150ml,平均80ml。术后平均住院10d,无严重并发症发生。随访4~33个月,无肿瘤复发。结论:采用后腹腔镜辅助小切口肾输尿管及膀胱袖套状切除术治疗肾盂及输尿管肿瘤具有患者创伤小、出血少、手术时间短、并发症少、切除更完全等优点。     

A case of synchronous ipsilateral renal cell carcinoma and transitional cell carcinoma]

A case of synchronous ipsilateral renal cell carcinoma with renal pelvic and ureteral transitional cell carcinoma is reported. A 80-year-old man, who had had transurethral resection of bladder tumor three times, was admitted on August, 1989 for recurrence of bladder tumor. Excretory pyelography revealed a filling defect of left renal pelvis. Findings of retrograde pyelography and computed tomography were in accord with those of the excretory urograms. Under a diagnosis of the left renal pelvic and ureteral tumor associated with the bladder tumor, left nephroureterectomy with bladder cuff resection was performed. Pathological diagnosis was renal pelvic and ureteral transitional cell carcinoma with renal cell carcinoma, which existed incidentally in the same kidney. Double unrelated primary carcinoma in urinary tract, especially, double dissimilar primary carcinoma in the same kidney, is rare. To our knowledge, this case is the 20th double cancer in upper urinary tract reported in Japan.     

A modified supine position to speed hand assisted retroperitoneoscopic nephroureterectomy: the Johnnie Walker position

PURPOSE: To minimize the operative time of hand assisted retroperitoneoscopic nephroureterectomy by avoiding position change we report an especially designed surgical position. MATERIALS AND METHODS: A total of 41 patients with upper tract transitional cell carcinoma who underwent hand assisted retroperitoneoscopic nephroureterectomy and bladder cuff resection were enrolled. Patients lay supine, and the flank and hip on the lesion side were elevated 30 degrees. The legs were extended and abducted in the Johnnie Walker position, allowing the operator to stand between them. Operation was completed via a 7 to 8 cm Gibson incision and 2 additional laparoscopic ports. RESULTS: All procedures were successful except 1 open conversion due to bleeding, in which there was no need to reposition the patient. Average patient age was 65.2 years (range 34 to 85), mean operative time was 207.6 minutes (range 130 to 345) and mean estimated blood loss was 166 ml (range 50 to 900). Simultaneous transurethral endoscopic procedures were performed in 11 patients in the same position. Time to oral intake and ambulation was 2.1 and 2.0 days, respectively. Two patients had postoperative complications, including pneumonia and wound hematoma in 1 each. No complication was related to the position. CONCLUSIONS: The Johnnie Walker position minimizes operative time by eliminating the delay caused by patient positioning and draping changes, allowing better coordination for the surgeon and assistant, and permitting more efficient use of the nondominant hand. The retroperitoneal approach prevents bowel interference in the visual field, making laparoscopic surgery in this modified supine position possible. Nephroureterectomy, bladder cuff resection and endoscopic procedures can be done with ease with the patient in this position.     

Skeletal muscle metastases from urothelial cell carcinoma

Hematogenous metastasis to skeletal muscle from urothelial carcinoma is extremely rare and metastatic disease to skeletal muscle tends to be found in people with advanced-stage neoplasm. We report in this paper a case of left sartorius muscle metastasis from urothelial cell carcinoma. A left nephroureterectomy with bladder cuff excision was performed and revealed a high-grade papillary transitional cell carcinoma (TCC) of the pelvis. And 6 month later, recurrent bladder cancer was found regular cystoscopy and then treated with transurethral resection of the bladder. After 6 times resection of bladder, an invasion into the bladder muscle layer was found. We recommended additional radical cystectomy to prevent the disease from advancing. However, the patient refused additional surgery. 6 month later, the patient complained of left thigh pain, so ultrasonography-guided biopsy of the nodular mass lesion in the left sartorius muscle was performed. The pathological analysis of the biopsy specimen revealed poorly differentiated metastatic urothelial carcinoma.     

Results of the treatment of carcinoma of the renal pelvis and ureter

Twenty-one patients with renal pelvic carcinoma and eighteen patients with ureteral carcinoma were treated with surgical therapy. In 14 of the 39 patients, we performed nephroureterectomy with a bladder cuff (NUpB), nephroureterectomy with total cystectomy (NUtB) in 12, nephrectomy with partial ureteric resection (NpU) in 8 and others in 5. Following surgery, 8 had recurrences and metastasis and 21 died with carcinoma and 10 survived without evidence of disease. The 5-year survival rate of the patients with renal pelvis carcinoma is 33.5% and 52.0% in ureteral carcinoma.