尿路上皮多器官癌

１９７５～１９９２年底在本院手术治疗病理证实的尿路上皮癌４１３例（肾盂移行上皮癌３４例；输尿管移行上皮癌１９例；胱移行上皮癌３５１例；尿道移行上皮癌９例）。如果以尿道肿瘤为１，各部位发生尿路上皮肿瘤机会之比为：肾盂：输尿管：膀胱：尿道＝３．７８：２．１１：３９：１。其中２２例属尿路上皮多器官癌。各部位发生多器官肿瘤的机会：肾盂１３／３４（３８．２３％），输尿管１４／１９（７３．６８％），膀胱１６／３５１（４．５６％），尿道４／９（４４．４４％）。非同时发生的肿瘤间期５～６２个月。其中一例尿路上皮癌者三年前患结肠癌。     

医源性输尿管下段损伤或狭窄的处理：（附14例报告）

为探讨对医源性输尿管损伤或狭窄的处理，降低并发症，回顾分析１９８６￣１９９６年治疗的医源性车尿管下段损伤１１例和狭窄３例（４侧），其中泌尿外科、妇科、普外科手术所造成的输尿管下段损伤或狭窄分别为９例（６４．３％）、４例（２８．６％）、１例（７．１％），以泌尿外科手术引起的发生率最高，可能与输尿管镜等腔道内手术的广泛开展及各类开放性手术的失误升并发症有关。除普外科造成的１例在损伤当即被发现并修复外，     

尿路上皮多器官癌九例报告

１９８４～１９９３年我院收治经手术和病理证实的尿路上皮癌共１３２例，其中９例属于尿路上皮多器官癌，占６．８２％。各部位发生多器官癌的机会：肾盂６／１６（３７．５０％），输尿管３／４（７５．００％），膀胱９／１０９（８．２６％），尿道２／３（６６．６７％）。本组９例中有７例为同时发生肿瘤，其中６例于术前同时明确肿瘤部位，诊断准确率８５．７１％。非同时发生肿瘤的２例，分别于肾盂癌术后６、２９个月再发生膀胱癌。本文强调对尿路上皮癌病人不满足于单一部位的诊断，常规行全泌尿系检查，以防多器官癌的漏诊；对肾输尿管上皮癌病人，术后膀胱灌注化疗和定期膀胱镜随访是必要的。     

原发性输尿管癌19例临床分析

分析原发性输尿管癌１９例，其中移行细胞癌１７例，腺癌１例，腺鳞癌１例。６８．４％为单发性肿瘤，３１．６％为多发性肿瘤，临床表现主要有肉眼血尿和腰痛，施行肾，输尿管及输尿管开口处膀胱袖口状切除１１例，肾，输尿管部分切除４例，输尿管部分切除，输尿管膀胱再植或输尿端端吻合４例。结果５年生存率为５５．６％《     

膀胱原位癌(附82例报告)

报告膀胱原位癌８２例，占本院同期收治膀胱肿瘤的９．５％，其中原发性原位癌１３例（１５．９％），伴发膀胱肿瘤的原位癌６９例（８４．１％），均经病理证实。尿脱落细胞学检查阳性率为９３．９％。术后或活检后采用ＢＣＧ膀胱内灌注治疗４６例，丝裂霉素Ｃ或阿霉素灌注治疗２０例，两组完全有效率（ＣＲ）分别为７５．０％和５５．６％，５年无瘤生存率分别为６５．０％和３８．５％。表明膀胱原位癌的最佳早期治疗方法为ＢＣＧ膀胱内灌注治疗。     

两种BTA试剂临床综合应用的研究

应用膀胱肿瘤抗原ｓｔａｔ（ＢＴＡｓｔａｔ）与膀胱肿瘤抗原ｔｅｓｔ（ＢＴＡｔｅｓｔ）两种测试方法对１２０例血尿患者尿样进行检测,探讨其单独及两者联合应用在膀胱肿瘤诊断中的价值。报告如下。材料和方法　１９９７年８月１日～１９９８年４月１日以血尿为首发症状的病人１２０例。年龄２１～８６岁,平均５６岁。男８８例,女３２例。其中膀胱移行上皮细胞癌４２例（３５．０％）;良性前列腺增生症３５例（２９．２％）;输尿管结石６例（５．０％）;输尿管息肉２例（１．６％）;肾盂上皮肿瘤和输尿管上皮肿瘤各１例（０．８％）…     

脊髓髓内肿瘤的诊断及其外科治疗

作者报告１７例脊髓髓内肿瘤的诊断及其外科治疗结果。病史２年以内者居多为７０．５％，２０～４０岁占７６．５％，首发症状主要为肢体麻木无力或（及）感觉异常，特有的临床表现和ＭＲＩ或ＣＴＭ检查为主要的临床诊断依据。病理诊断以颈段、颈胸段及上胸段室管膜瘤多见共９例，其次是星形细胞瘤４例。１７例均经后路手术：肿瘤全部切除９例，其中室管膜瘤７例，大部切除减压５例，脊髓背侧切开减压活检３例。随访６个月～４９．３月，平均１１．８个月，神经机能明显改善者８例，脊髓机能评分提高１１～２０分者５例，１０分以下者３例，病情稳定者４例。本文重点讨论其诊断、手术要点及其应注意事项     

膀销原位癌（附82例报告）

报告膀胱原位癌８２例，占本院同其收治膀胱肿瘤的９．５％，其中原发性原位癌１３例（１５．９％），伴发膀胱肿瘤的原位癌６９例（８４．１％），均经病理证实。悄脱落细胞学检查阳性率为９３．９％。术后或活检后采用ＢＣＧ膀胱内灌注治疗４６例，丝裂霉素Ｃ或阿霉素灌注治疗２０例，两组完全有效率（ＣＲ）分别为７５．０％和５５．６％，５年无瘤生存率分别为６５．０％和３８．５％．表明膀胱原位癌的最佳早期治疗方法为ＢＣＧ     

顺铂膀胱灌注引起急性过敏反应（附六例报告）

１９９０年６月～１９９３年４月对６４例膀胱癌术后病人行小剂量顺铂（４０ｍｇ／次）膀胱灌注，发生过敏性反应６例，发生率为９．４％，其中２例发生过敏性休克。本组６例过敏反应分别发生在灌注第１１、１０、２１、５、２７、１４次时，平均为第１４．７次时。２例终止灌注，４例改用丝裂霉素灌注。     

原发性T1G3膀胱移行上皮细胞癌的保守性手术治疗(附40例报告)

为探讨原发性Ｔ１Ｇ３膀胱移行上皮细胞癌保守治疗的效果，近１１年来采用经尿道电切膀胱肿瘤（ＴＵＲＢｔ）辅以膀胱内丝裂霉素Ｃ及噻替哌化学疗法治疗４０例原发性Ｔ１Ｇ３膀胱移行上皮细胞癌病人。平均随访时间４７．８个月（７～１３１个月）。４０例病人中７例（１７．５％）术后平均２１个月（５～３３个月）复发浅表性肿瘤。１例因肿瘤复发于后尿道和膀胱三角区而施行根治性膀胱切除及可控性右半结肠代膀胱术，１例肿瘤复发距输尿管开口较近而作膀胱部分切除术。另１例出院后５个月则因脑血管意外死亡。至本研究结束为止，本组病人的５年和１０年无癌生存率分别为８２．４％和６６．７％（ＫａｐｌａｎＭｅｉｅｒ分析）。结论：为提高病人的无癌生存率和生活质量，对符合保守性手术疗法条件的原发性Ｔ１Ｇ３膀胱移行上皮细胞癌采取ＴＵＲＢｔ辅以膀胱内化疗作为最初的治疗，是一个合理的选择。     

肿瘤浸润或转移致输尿管梗阻性肾功能衰竭的处理

目的探讨由于肿瘤浸润或转移至后腹膜压迫输尿管引起的梗阻性肾功能衰竭的处理方法。方法报告25例此种患者的临床资料,原发灶为消化道肿瘤11例,泌尿生殖系肿瘤等13例,原发灶不明1例。采用CT扫描明确输尿管梗阻部位12例,MRU扫描5例,B超检查12例,IVU检查6例;并且明确肿瘤转移与梗阻的关系。采用双J导管内引流9例,输尿管皮肤造瘘10例,肾造瘘术6例。结果15例经治疗后肾功能完全恢复正常,10例肾功能有改善。结论CT扫描和MRU对于梗阻部位定位准确且无创;采用双J导管内引流和造瘘外引流损伤小,简便而效果好。     

盆腔器官肿瘤浸润或术后放疗致输尿管梗阻的处理

目的探讨盆腔器官肿瘤浸润或术后放疗致输尿管梗阻的诊治方法。方法回顾性分析1990年6月至2000年5月经临床处理的15例本病的临床资料,其中双J管内引流或输尿管导管引流术6例,经皮肾穿刺造瘘术4例。行开放性肾造瘘术3例,输尿管皮肤造瘘术2例。结果本组15例经尿流改道或内引流后全身状况及尿毒症症状很快好转,其中7例肾功能恢复正常,8例肾功能改善。结论B超、输尿管逆行插管和／或磁共振尿路水成像(MRU)检查是较好的诊断手段。输尿管插管引流或双J管内引流和经皮肾穿刺造瘘术。具有损伤小、对患影响轻的优点,是解除梗阻的首选方法。     

各类输尿管瘘原因及预后分析

目的对输尿管瘘患者临床资料及不同处理方式疗效进行回顾分析，总结临床诊治经验。 方法我科自2013年5月至2018年5月共收治19例各类原因所导致的输尿管瘘患者，其中男性4例，女性15例，平均年龄为（51±13）岁。19例患者中，17例患者首先进行输尿管镜检+输尿管支架管（双J管）置入术，如输尿管镜检失败，则视情况改行肾造瘘术或输尿管膀胱再植术；2例因感染较重，且腹膜后尿囊明显，遂行尿囊穿刺引流术+患肾造瘘术。 结果8例患者成功行输尿管镜检+双J管置入术，5例最终恢复正常；9例逆行输尿管镜检失败的患者，3例直接同期行输尿管膀胱再植术；6例改行肾造瘘术，其中3例因后期瘘口未愈，半年后行输尿管膀胱再植术。3例患者因反复感染，最终切除患肾。 结论如果Ⅰ期输尿管镜检查术可恢复输尿管连续性，可尝试留置双J管；如Ⅰ期输尿管镜检查术失败，患者条件允许情况下，则应选择同期行输尿管修补术或输尿管膀胱再植术，单纯行肾造瘘术只会延长病程并不能改变患者最终结局；感染是导致输尿管瘘患者最终切肾的主要因素。     

OPTIMAL METHOD OF URGENT DECOMPRESSION OF THE COLLECTING SYSTEM FOR OBSTRUCTION AND INFECTION DUE TO URETERAL CALCULI

Purpose

We compare the efficacy of percutaneous nephrostomy with retrograde ureteral catheterization for renal drainage in cases of obstruction and infection associated with ureteral calculi.

Materials and Methods

We randomized 42 consecutive patients presenting with obstructing ureteral calculi and clinical signs of infection (temperature greater than 38C and/or white blood count greater than 17,000/mm.³) to drainage with percutaneous nephrostomy or retrograde ureteral catheterization. Preoperative patient and stone characteristics, procedural parameters, clinical outcomes and costs were assessed for each group.

Results

Urine cultures obtained at drainage were positive in 69.9% of percutaneous nephrostomy and 19.1% of retrograde ureteral catheterization patients. There was no significant difference in the time to treatment between the 2 groups. Procedural and fluoroscopy times were significantly shorter in the retrograde ureteral catheterization (32.7 and 5.1 minutes, respectively) compared with the percutaneous nephrostomy (49.2 and 7.7 minutes, respectively) group. One treatment failure occurred in the percutaneous nephrostomy group, which was successfully salvaged with retrograde ureteral catheterization. Time to normal temperature was 2.3 days in the percutaneous nephrostomy and 2.6 in the retrograde ureteral catheterization group, and time to normal white blood count was 2 days in the percutaneous nephrostomy and 1.7 days in the retrograde ureteral catheterization group (p not significant). Length of stay was 4.5 days in the percutaneous nephrostomy group compared with 3.2 days in the retrograde ureteral catheterization group (p not significant). Cost analysis revealed that retrograde ureteral catheterization was twice as costly as percutaneous nephrostomy.

Conclusions

Retrograde ureteral catheterization and percutaneous nephrostomy effectively relieve obstruction and infection due to ureteral calculi. Neither modality demonstrated superiority in promoting a more rapid recovery after drainage. Percutaneous nephrostomy is less costly than retrograde ureteral catheterization. The decision of which mode of drainage to use may be based on logistical factors, surgeon preference and stone characteristics.     

急性输尿管结石梗阻致肾感染的微创治疗

目的 探讨微创技术治疗急性输尿管结石梗阻致肾感染的临床疗效.方法 自2007年5月至2011年9月,对26例急性输尿管结石梗阻导致肾感染患者行微创手术治疗.26例均有患侧腰腹部疼痛,有不同程度发热,体温介于37.3～39.7℃之间.所有患者术前均接受抗感染、对症支持等常规治疗3～7 d,其中10例感染症状好转,随后接受微创手术碎石;另外16例经常规治疗后感染情况未明显好转,而先行输尿管置管(7例)或经皮肾穿刺造瘘(9例)引流尿液,待感染情况好转后再接受微创手术.患者均接受经尿道输尿管镜取石术或经皮肾镜取石术.结果 19例行经尿道输尿管镜取石术,7例经皮肾镜取石术.手术均成功解除尿路梗阻,结石取净率95.2%.术中无输尿管穿孔、大出血、气胸、尿外渗、肾周血肿、腹腔脏器损伤等并发症发生.术后2～8 d后,所有患者体温和血白细胞数降至正常.随访3～12个月,患侧肾无萎缩,无输尿管狭窄发生.结论 在有效控制感染的情况下,采用微创技术治疗急性输尿管结石合并肾感染,具有创伤小、安全性高、效果好等优点,可作为结石合并肾感染的一种治疗选择.     

硬性输尿管镜术中入镜困难的处理(附72例报告)

目的总结硬性输尿管镜术中入镜困难的处理经验。方法1995年1月-2004年11月，应用F8/9.8输尿管硬镜逆行治疗640例输尿管结石，72例入镜困难，通过控制液压灌注泵压力、改变病人体位、扩张输尿管、肾穿刺造瘘等方法处理。结果成功入镜54例，18例改开放手术。术中并发症16例，其中10例黏膜部分撕裂，6例输尿管穿孔（放置支架管引流后治愈）。56例随访13—36个月，平均16个月，静脉肾盂造影显示输尿管通畅。结论熟悉输尿管的解剖与病理生理特点，入镜成功的关键在于手术者的操作技巧与经验。     

Laparoscopic onlay lingual mucosal graft ureteroplasty combined with ureterovesical reimplantation for one-stage reconstruction of complex ureteral strictures: a case report

The treatment of ureteral stricture is a challenging task, especially when multiple strictures are present. Here, we report on a 63-year-old male patient diagnosed with hydronephrosis with left ureteral strictures who was admitted to our hospital. During treatment, a left percutaneous nephrostomy tube was inserted for hydronephrosis. Antegrade and retrograde pyelography were performed simultaneously. The results suggested there were 3 segment ureteral strictures in the left ureter: 2 located in the distal ureter and 1 in the proximal ureter. The treatment choices for multiple ureteral strictures are kidney autotransplantation or an ileal ureteral replacement (IUR), which are both morbid procedures and are technically challenging. With the excellent results of lingual mucosal graft (LMG) in ureteroplasty, this patient underwent a one-stage left ureter reconstruction with combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation. However, disease of the oral mucosa and a reduced bladder volume caused by radio cystitis or chemical cystitis, may limit the use of this technique. Regular postoperative antegrade pyelography and the Whitaker test showed the unimpeded drainage of the left ureter. Based on the satisfactory outcome of this patient, combined laparoscopic LMG ureteroplasty and ureterovesical reimplantation for unilateral multiple ureteral strictures is a viable option that has fewer complications.     

Immediate closure of nephrostomy tube wounds using a tissue adhesive: a novel approach following percutaneous endourological procedures

PURPOSE: We assessed the feasibility of immediate sealing of nephrostomy tube wounds after percutaneous surgery using a tissue adhesive. MATERIALS AND METHODS: The study represents a prospective series of 27 consecutive percutaneous procedures. After nephrostographic exclusion of infrarenal urinary obstruction the nephrostomy tubes were removed and the wound edges were glued together using 2-octyl cyanoacrylate. The wound was covered by gauze to assess the efficiency of sealing and the patients were followed clinically. Another consecutive series of 20 patients who had been treated during 6 months before the current study were used for comparison. The nephrostomy wound in this group was dressed and left to close spontaneously. RESULTS: A total of 27 percutaneous procedures were performed in 25 patients with a median age of 51 years (range 9 to 77). There were 26 cases of percutaneous nephrolithotomy for an average stone burden of 32.6 mm. (range 16 to 70) and 1 pediatric case of percutaneous antegrade balloon dilation of ureteral stricture related to Cohen reimplantation. Median size of the nephrostomy tubes was 16Fr (range 12Fr to 24Fr) and they were maintained a median of 4 days (range 1 to 16) postoperatively. Urinary leakage ceased immediately after tissue adhesive application in all cases. One patient in whom renal colic developed secondary to edema of the ureteral orifice underwent temporary stenting in retrograde fashion. There were no additional complications at a median followup of 5 months (range 3 to 7). The study group had a significantly shorter hospital stay than the wound dressing group (p <0.001). CONCLUSIONS: Wound sealing following nephrostomy tube removal using 2-octyl cyanoacrylate appears to be a safe, simple and efficient method for immediate abolishment of urinary leakage. This novel approach avoids patient and medical personnel inconvenience, permitting early release from the hospital without physical and social limitations related to persistent wound urinary discharge.     

Minimally invasive management of Crohn's disease complicated by ureteral stenosis

Ureteral involvement due to Crohn's disease occurs in 3% to 6% of cases. Herein, we present a case of a 22-year-old woman with ileocolic Crohn's disease with right hydronephrosis due to compression of the ureter that was resolved with a 3-stage, minimally invasive procedure (preoperative percutaneous nephrostomy, ureteral stent placement, and sequential laparoscopically assisted ileocolectomy). Percutaneous right nephrostomy drainage permitted us to prevent renal damage before surgery, and successive ureteral double-J catheter placement minimized the risk of ureteral damage during the laparoscopic procedure. The safety and feasibility of sequential minimally invasive management of ileocolonic Crohn's disease involving the right ureter was assessed, and a good cosmetic result was achieved.