后腹腔镜肾切除术23例报告

目的探讨后腹腔镜肾切除术的可行性及临床应用价值。方法2005年7月～2009年2月行后腹腔镜肾癌根治性切除术16例,肾盂癌根治性切除术3例,结核肾切除2例,萎缩肾切除2例。结果23例均获成功,无中转开放者。手术时间100～240min,平均（130±11）min;出血量40-200mL,平均（100±10）mL;术后住院时间4～7d,平均6．5d;术中及术后无明显并发症。术后病检报告：肾透明细胞癌16例,肾盂移行细胞癌3例。随访2～28个月,未见肿瘤复发及穿刺通道的种植转移。单纯肾切除亦无其他并发症。结论后腹腔镜肾切除术安全可行、疗效肯定。     

前列腺混合性癌行机器人辅助根治性前列腺切除术后穿刺孔转移1例报告

前列腺癌种植转移罕见。本文报道1例前列腺混合性癌, 于外院行前列腺穿刺活检示前列腺腺泡腺癌, 行机器人辅助腹腔镜根治性前列腺切除术, 术后病理示前列腺混合性癌, 小细胞癌为主。术后5个月于外院发现穿刺孔转移。于我院行化疗联合免疫治疗6个周期, 维持药物去势及免疫治疗。化疗结束后3个月, 影像学检查评估肿瘤完全缓解。免疫治疗维持治疗10个月后因不良反应停药。免疫治疗停药后15个月肿瘤无进展生存。     

腹膜后腹腔镜肾癌根治术的体会(附58例报告)

目的：总结后腹腔镜肾癌根治性切除术的经验。方法：回顾分析行后腹腔镜肾癌根治性切除术58例的临床资料。结果：58例腹腔镜肾癌根治手术均获成功,手术时间50～185min,平均120min。术中出血量50～400ml,平均150ml。随访0.5～5年,均无复发,穿刺孔种植转移1例。结论：后腹腔镜肾癌根治术是一种安全、有效的治疗方法,应重视穿刺孔种植转移问题。     

后腹腔镜肾癌根治性切除术

目的:探讨后腹腔镜肾癌根治性切除术的可行性及临床应用价值。方法:2002年10月~2005年12月行后腹腔镜肾癌根治性切除术56例。结果:56例均获成功,无中转开放者。手术时间80~210min,平均138min;出血量40~200ml,平均110ml;术后住院时间4~7天,平均6.5天;术中及术后无明显并发症。术后病检报告:肾透明细胞癌43例,肾颗粒细胞癌7例,肾梭形细胞癌3例,肾腺癌2例,肉瘤样腺癌1例。随访2~28个月,未见肿瘤复发及穿刺通道的种植转移。结论:后腹腔镜肾癌根治性切除术安全可行、疗效肯定。     

后腹腔镜联合经尿道输尿管口电切术治疗肾盂输尿管肿瘤(附17例报告)

目的:评估后腹腔镜联合经尿道输尿管口电切术治疗肾盂、输尿管肿瘤的临床疗效。方法:2008年10月至2013年1月为17例肾盂或输尿管移行细胞癌患者行后腹腔镜根治性肾输尿管切除术,其中肾盂癌11例,输尿管癌6例。经尿道袖状电切患侧输尿管口周围1 cm范围膀胱壁,采用后腹腔镜切除肾及全长输尿管,完整取出切除的肾输尿管。术后常规吡柔比星膀胱灌注。结果:手术时间平均(186.9±30.2)min;术中出血量平均(110.1±38.6)ml;术中、术后未发生明显并发症。术后随访3～51个月,1例发生膀胱移行细胞癌。结论:后腹腔镜联合经尿道电切镜治疗肾盂癌、输尿管癌具有手术损伤小、康复快等优点,且不增加肿瘤种植风险,临床应用前景良好。     

腹腔镜根治性肾输尿管切除术治疗上尿路肿瘤

目的:评价腹腔镜根治性肾输尿管切除术治疗上尿路移行细胞癌的有效性和安全性.方法:对26例上尿路肿瘤患者,其中2例曾有同侧肾移植史,行腹腔镜根治性肾输尿管切除及膀胱黏膜袖套状切除术,并记录其有关指标.结果:26例均手术成功,其中3例采用经腹腔途径,23例经后腹腔途径.平均手术时间120 min,术中出血量46 ml,术后住院时间10.5 d,恢复正常活动时间4.1周.20例随访6～38个月,1例局部腹膜后肿瘤复发,1例膀胱内复发;无远处转移及穿刺通道的种植性转移.结论:腹腔镜根治性肾输尿管切除术治疗上尿路移行细胞癌是安全、有效的微创手术方法,但其对肿瘤细胞生物学行为的影响尚需作进一步的评价.     

后腹腔镜加下腹小切口术治疗上尿路肿瘤(附18例报告)

目的探讨腹腔镜对肾盂或输尿管癌等上尿路肿瘤根治性切除术的手术方法,对加用下腹小切口术式的临床效果进行评价。方法回顾性分析18例行后腹腔镜加下腹部小切口肾盂癌或输尿管癌根治性切除术患者的临床资料及手术方法。结果手术均获成功,无一例中转开放;平均手术时间为120～176min,术中平均出血量110～200ml;术后肠功能恢复时间平均为26～48h,手术后30～48h下床活动;术后平均住院时间为6～8d。术中、术后未发生明显并发症。随访2～36个月均未见肿瘤复发及转移。结论后腹腔镜加下腹部小切口行肾盂癌和输尿管癌根治术是一种安全有效的微创方法,与传统开放手术和其他术式相比,具有手术时间短、出血少、恢复快、术后并发症少等优点。     

腹腔镜胆囊切除术后切口肿瘤种植的临床分析

目的:探讨腹腔镜胆囊切除术(LC)后切口肿瘤种植的诊断治疗及预防措施。方法:回顾分析1994年1月至2003年12月诊治LC术后切12肿瘤种植病例的临床资料。结果:LC 10 865例术后发生切口肿瘤种植4例(0.037％),表现为剑突下戳孔处质硬肿块,病理证实为转移性腺癌,但无法找到原发病灶。行肿块扩大切除后辅以局部放疗及全身化疗,分别随访40、20、10、1个月,1例在发现切口种植后3月因肿瘤远处转移死亡,1例在发现剑突下肿块后4月脐孔戳口处又见转移性腺癌,手术探查可见腹膜肿瘤种植,另2例未见肿瘤复发及转移。结论:LC术后切口肿瘤种植发生率低,但预后差,传统胆囊病理检查可漏诊原发癌灶。认识其临床表现与发病机制,有利于更好地指导临床工作。     

腹腔镜肾切除术73例临床分析

目的:总结腹腔镜肾切除术的手术方法及临床应用价值。方法:回顾分析2002年1月至2009年10月为73例患者施行腹腔镜肾切除术的临床资料。69例经后腹腔途径,4例经腹腔途径。结果:71例手术成功,2例中转开放手术。手术时间110～230min,术中出血50～200ml,3例术后切口感染,术后住院5～14d。术后随访22例肾癌及7例肾盂癌患者4～37个月,未见局部复发、远处转移及穿刺孔种植转移。结论:腹腔镜肾切除术安全、有效,患者创伤小,具有良好的临床应用前景。     

后腹腔镜联合下腹部小切口肾盂癌根治术的疗效观察

目的:探讨后腹腔镜联合下腹部小切口行根治性肾输尿管全切除术治疗肾盂癌的可行性及手术疗效。方法:回顾分析2009年11月至2014年7月为29例患者行后腹腔镜联合下腹部小切口技术肾盂癌根治术的临床资料。手术采用腰部三孔法切除患侧肾脏并尽量向膀胱侧游离输尿管,由下腹部5~7 cm小切口取出标本,直视下袖状切除输尿管膀胱壁内段,缝合膀胱切口。结果:29例手术均获成功,无中转开放手术。手术时间100~210 min,平均(150.0±43.5)min;术中出血量50~350 ml,平均(120.0±59.6)ml;术后住院8~12 d,平均(9.5±1.1)d。术后病理均提示尿路上皮癌。术后随访3~48个月,1例发生膀胱肿瘤,1例发生患侧腹膜后复发并双肺转移。结论:对于经验丰富且技术娴熟的外科医生,后腹腔镜联合下腹部小切口肾盂癌根治术是安全、有效的。     

Oncological safety of laparoscopic surgery for urological malignancy: experience with more than 1,000 operations

PURPOSE: Although laparoscopy is being increasingly used to treat urological malignancies, there is still concern regarding the induction of local recurrence and port site metastasis. To our knowledge no major clinical study with long-term followup has been presented in the field of urological laparoscopy. We assessed the oncological safety of laparoscopy with emphasis on incidence of local recurrence and port site metastasis, analyzing the risk factors for such events based on a 10-year experience. MATERIALS AND METHODS: From June 1992 to May 2002 we performed 1,098 laparoscopic procedures for urological malignancies, including 450 radical prostatectomies, 478 pelvic and 80 retroperitoneal lymph node dissections, 45 radical nephrectomies, 22 radical nephroureterectomies, 12 partial nephrectomies and 11 adrenalectomies. In 418 cases of laparoscopic radical prostatectomy pelvic lymphadenectomy was done simultaneously. Of the procedures 917 were performed transperitoneally, including 181 via retroperitoneal or extraperitoneal access. A total of 567 procedures were performed in case of histologically proven cancer, whereas 531 represented only staging operations. RESULTS: Median followup was 58 months (range 4 to 127). Eight local recurrences were observed (0.73% overall, 1.41% of histologically proven cases). There were recurrences after nephroureterectomy for transitional cell carcinoma of the ureter in 1 patient, after radical nephrectomy for renal cell carcinoma in 1, growing teratoma after retroperitoneal lymph node dissection in 2, local recurrence of prostate cancer in 3 and after removal of an adrenal metastasis of melanoma in 1. Two port site metastases (0.18% overall, 0.35% of histologically proved cases) occurred, including metastasis of small cell lung carcinoma after adrenalectomy and a residual mass following 2 cycles of chemotherapy after retroperitoneal lymph node dissection. CONCLUSIONS: According to our experience the incidence of local recurrence and the risk of port site metastases is low and seems to be mainly related to the aggressiveness of the tumor and immunosuppression status of the patient, respectively rather than to technical aspects of the laparoscopic approach.     

联合应用多种内腔镜一期诊断和治疗早期肾盂癌（附8例报告）

目的：探讨多种内腔镜在早期肾盂癌诊断和治疗中的联合应用价值。方法：8例肾盂癌患者运用输尿管软硬镜或经皮。肾镜诊断,并一期采用后腹腔镜联合经尿道输尿管切开,行肾输尿管全长切除及膀胱输尿管开口袖套状切除。术后病理诊断为G,5例,G2 3例,T1N0M0 5例,T2N0M0 3例。结果：8例均顺利完成手术,手术时间平均150min,术中出血量平均120ml。导尿管留置时间为7天左右,术后2～4天下床活动。均无漏尿、切口感染等并发症。仅1例因淋巴漏,皮管引流至术后2周拔除。随访6～18个月,患者均无瘤生存,未见肿瘤复发、转移及切口肿瘤种植。结论：通过联合应用多种内腔镜,可以在明显提高肾盂癌的诊断率的基础上,一期完成腹腔镜肾盂癌根治性切除,最大限度地减少患者手术创伤和手术并发症。     

Carcinological risks and retroperitoneal laparoscopy

PURPOSE: To determine the incidence of trocar site spillage, local recurrence, and metastatic disease associated with retroperitoneal laparoscopic tumor resection. METHODS: From 1994 to 1999, 228 retroperitoneal laparoscopic procedures were performed at our institution. Fifty-six procedures (24.6%) were for malignancies and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumors, and 7 nephro-ureterectomies for renal pelvis tumors. The pathological stage and the status of surgical margins were noted according to the 1997 TNM classification. Postoperative follow-up data were obtained by means of physical and radiological examinations after 1 and 3 months, and then half-yearly. Trocar site seeding, local recurrence and metastatic disease were recorded. Kaplan-Meier actuarial analysis was used to determine the disease-free survival likelihood. RESULTS: The mean follow-up was 24.9+/-13.85 months. All the patients had tumor-free surgical margins. No laparoscopic trocar site recurrences were identified. For laparoscopic radical nephrectomy: one patient had a local recurrence with hepatic metastasis of a pT(3)G(2) tumor after 9 months and died 19.7 months after the procedure. One patient with a pT(3a)G(3)M+ tumor died 23.1 months after radical nephrectomy without any sign of local recurrence. For laparoscopic nephro-ureterectomy: one patient with a pT(3)G(3) tumor had a local recurrence 12.1 months after the procedure and died 26.6 months after surgery. One patient with a pT(1)G(2) renal pelvis tumor had bone metastasis at 9 months and died 29 months after the procedure. The Kaplan-Meier actuarial disease-free survival rate was 91% at 54 months for radical nephrectomy, 61% at 30 months for nephro-ureterectomy and 100% at 49 months for partial nephrectomy. CONCLUSION: Malignancies of the upper urinary tract can be managed by means of retroperitoneal laparoscopy. Short-term results suggest that this procedure is not associated with an increased risk of portsite or local recurrence, and that disease-free survival is equivalent to that obtained with open surgery.     

Radical Second Resection Provides Survival Benefit for Patients with T2 Gallbladder Carcinoma First Discovered after Laparoscopic Cholecystectomy

Port site recurrence or peritoneal seeding is a fatal complication following laparoscopic cholecystectomy for gallbladder carcinoma. The aims of this retrospective analysis were to determine the association of gallbladder perforation during laparoscopic cholecystectomy with port site/peritoneal recurrence and to determine the role of radical second resection in the management of gallbladder carcinoma first diagnosed after laparoscopic cholecystectomy. A total of 28 patients undergoing laparoscopic cholecystectomy for gallbladder carcinoma were analyzed, of whom 10 had a radical second resection. Five patients had recurrences; port site/peritoneum recurrence in 3 and distant metastasis in 2. The incidence of port site/peritoneal recurrence was higher in patients with gallbladder perforation (3/7, 43%) than in those without (0/21, 0%) (p = 0.011). The outcome after laparoscopic cholecystectomy was worse in 7 patients with gallbladder perforation (cumulative 5-year survival of 43%) than in those without (cumulative 5-year survival of 100%) (p <0.001). Among 13 patients with a pT2 tumor, the outcome after radical second resection (cumulative 5-year survival of 100%) was better than that after laparoscopic cholecystectomy alone (cumulative 5-year survival of 50%) (p = 0.039), although there was no survival benefit of radical second resection in the 15 patients with a pT1 tumor (p = 0.65). In conclusion, gallbladder perforation during laparoscopic cholecystectomy is associated with port site/peritoneal recurrence and worse patient survival. Radical second resection may be beneficial for patients with pT2 gallbladder carcinoma first discovered after laparoscopic cholecystectomy.     

后腹腔镜下肾输尿管全切除术治疗低分化肾盂癌:与开放手术的比较

目的 通过与开放手术比较,评价后腹腔镜手术治疗低分化肾盂癌的临床应用价值.方法 肾盂癌患者33例,病理为肿瘤局限于肾脏(T1N0M0～T3N0M0),细胞分化3级.12例行后腹腔镜下肾输尿管全切联合下腹部小切口切除患侧输尿管口,21例行开放性肾盂癌根治术,比较2组的临床疗效.结果腹腔镜组和开放手术组的平均手术时间分别为(232±36)和(212±17)min(P=0.100),术中平均出血量分别为(162±64)和(233±51)ml(P=0.001),术后肠道恢复时间为(2.5±0.5)和(3.9±0.3)d(P＜0.001),术后平均住院时间为(7.6＜0.9)和(9.8±1.1)d(P＜0.001).术后随访7～67个月,腹腔镜组患者无肿瘤复发或转移;开放组患者中术后1年腹膜后复发1例,发生浅表性膀胱癌3例,无患者死亡.结论 后腹腔镜联合下腹部小切口的肾盂癌根治术能有效治疗肿瘤局限但细胞分化差的患者,且创伤小、患者恢复快.     

腹腔镜肾盂切开取石术联合切取法活检术在肾铸型结石合并肾盂癌诊治中的作用

本研究回顾性分析了2015年3月至2019年6月浙江大学医学院附属第二医院收治的3例肾铸型结石合并肾盂癌患者的病例资料,男2例,女1例。年龄52~81岁。既往均有腔镜碎石术史。3例术前检查发现肾盂或肾盂输尿管连接处可疑占位。3例均行腹腔镜肾盂切开取石术,术中切取占位组织活检,分别确诊为肾盂中-低分化鳞癌、浸润性尿路上皮...     

Port-site metastasis: the influence of biology

OBJECTIVE: Several surgical and technical mechanisms have been proposed for the development of port-site metastasis, but the influence of tumor and host biologic factors has not been emphasized. We present a case of a pelvic chordoma that metastasized to a prior laparoscopic radical nephrectomy port-site. METHODS: A 62-year-old woman underwent laparoscopic radical nephrectomy (LRN) for a pT1b grade 3 renal cell carcinoma, followed 6 weeks later by resection of a sacral chordoma. The incisions and areas of dissection for the two procedures were discontinuous. RESULTS: Eight months following the LRN she developed a nodule in one of the laparoscopic port-sites. The port-site metastasis was treated with wide surgical resection, which was confirmed as metastatic chordoma on histologic examination. CONCLUSION: Based on the chronological sequence and physical distance between surgical sites, only biological factors could have contributed to this port-site metastasis. This unusual case highlights the important role that tumor and host biologic mechanisms play in the development of port-site metastasis.     

不同肾盂癌根治术式的疗效观察

目的比较后腹腔镜根治性肾切除联合经尿道电切及联合下腹部小切口治疗肾盂癌的手术方法及效果。方法回顾性分析11例后腹腔镜肾输尿管全切联合经尿道膀胱输尿管袖套状切除(电切组)及15例联合下腹部小切口(切口组)进行肾盂癌根治术患者的临床资料,通过对手术时间、术中出血量、术后肠道恢复时间、术后住院时间、局部复发及转移等数据进行统计,对两种术式的操作步骤进行比较、总结并以同期开展的16例开放性肾盂癌根治性手术(开放组)做对照。结果电切组及切口组手术时间、出血量、肠道恢复时间、引流管拔出时间、术后住院天数比开放组均有明显优势,差异有统计学意义(P<0.05)。电切组与切口组手术时间、引流管拔除时间比较,差异有统计学意义(P<0.05)。术中出血量、术后住院天数、局部复发及转移,差异无统计学意义(P>0.05)。切口组1例,开放组2例出现术后切口感染。术后随访3³9个月,电切组1例局部复发,1例发生膀胱癌;切口组1例发生膀胱癌,1例肺转移。开放组1例局部复发,1例发生膀胱癌,1例肺转移。结论电切组较切口组手术时间短,没有增加出血量及术后复发、转移、肿瘤种植风险,但无下腹部切口,具有创伤小、恢复快、美观等优点,值得临床推广应用。     

伴有肾静脉瘤栓的左肾癌全腹腔镜根治术

目的：探讨左肾癌并肾静脉瘤栓患者行经后腹腔途径全腹腔镜左肾痛根治术的可行性。方法：3例左肾癌伴左。肾静脉瘤栓患者均在全麻下行经后腹腔全腹腔镜左肾癌根治术：术中放置4个穿刺套管针,游离腹主动脉和肾动脉后,用Hem—o-lok结扎切断肾动脉,于肾静脉近下腔静脉处用Hem-o-lok结扎切断肾静脉,完整切除。肾脏及瘤栓。结果：3例手术均获得成功,术后恢复良好,5灭出院。病理检查分别诊断为肾透明细胞癌2例,嫌色细胞癌1例。术后随访1～3个月,未见肿瘤复发和转移。结论：对选择性左肾癌并肾静脉瘤栓患者行经后腹腔全腹腔镜左。肾癌根治术完全可行。