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。     

全腹腔镜根治性肾输尿管全长切除术治疗肾移植术后上尿路肿瘤

目的：评价全腹腔镜根治性肾输尿管全长切除术治疗肾移植术后上尿路移行细胞癌的有效性和安全性。方法：回顾性分析2008年1月～2011年9月收治13例肾移植术后并发上尿路肿瘤患者资料,男3例,女10例,年龄32～64岁,肾移植术后18～65个月,行全腹腔镜根治性肾输尿管全长切除16次（3例为先后双侧发生）。4例次肿瘤与移植肾位于同侧（其中2例有剖宫产和子宫切除等下腹部手术史）。先行经尿道用针形电极环绕输尿管管口行袖套状切除,再改变体位行腹膜外途径全腹腔镜根治性肾输尿管全长切除术。下段输尿管在腔镜直视下分离至髂总血管分叉以下,并记录其有关指标。结果：16例次手术均成功,手术时间120～230min,平均178min;术中出血量20～260ml,平均80ml;术后住院时间11～16d,平均12．5d。13例随访3～48个月,无腹膜后肿瘤复发,1例膀胱内新发肿瘤。无远处转移及穿刺通道的种植性转移。结论：腹膜后途径全腹腔镜根治性肾输尿管全长切除术治疗。肾移植后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。     

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.     

MRU对肾移植术后原自体无功能肾、输尿管移行细胞癌的诊断价值(附21例报告)

目的：探讨磁共振水成像(Magnetic resistance urography,MRU)在肾移植术后对原自体无功能性肾、输尿管移行细胞癌的诊断价值。方法：对21例肾移植术后临床诊断为肾盂或输尿管移行细胞癌患者进行MRU检查,同时行逆行肾盂输尿管造影;11例行输尿管镜及病理学检查,并行MRU诊断。16例行经尿道输尿管口环形切开、腰部一处切口的肾输尿管全长切除术。结果：术前21例MRU检查均提示肾盂、输尿管有占位性病变,11例配合输尿管镜得出组织学诊断,术前诊断与手术结果一致。21例中,16例采用肾输尿管全长切除术均获得成功。结论：MRU对肾移植术后IVU不显影的原无功能性肾、输尿管移行细胞癌具有重要的临床诊断价值;输尿管口切除、肾输尿管全长切除术对移植肾同侧原肾发生肾盂输尿管癌一样有效。     

后腹腔镜双侧一期肾输尿管全长切除术——肾移植术后原上尿路移行细胞癌8例报告

目的探讨肾移植术后发现原肾肾盂癌和(或)输尿管癌一期行后腹腔镜双侧肾输尿管全长切除术的安全性与可行性。方法 2006年4月~2009年11月对8例肾移植术后发现原肾肾盂癌和(或)输尿管癌行腹腔镜下双侧一期肾输尿管全长切除。先取左侧卧位,后腹腔镜下游离右侧肾及输尿管,输尿管远端用钛夹夹闭;改为右侧卧位后同法处理左侧肾及输尿管;然后取截石位,经尿道用电切镜袖状切除双侧输尿管膀胱膀胱壁内段;最后取下腹正中6 cm切口取出标本。结果 8例均行后腹腔镜双侧肾输尿管全长切除联合经尿道膀胱袖状切除,其中1例因膀胱内发现肿物同时行经尿道膀胱电切术,无中转开腹。手术时间(346.9±105.4)min(230~574 min);术中出血量(162.5±102.6)ml(100~400 ml),均无输血;住院时间(18.3±5.7)d(12~49 d)。病理报告均为尿路上皮癌,其中2例为双侧病变,此2例中有1例合并膀胱癌。8例随访(22.6±14.2)月(6~49个月),其中1年6例,均存活,1例膀胱癌复发相继行电切、膀胱部分切除治疗。结论肾移植术后原肾肾盂癌或输尿管癌一期行后腹腔镜双侧肾输尿管全长切除术是一种安全可行的治疗方式。     

后腹腔镜肾输尿管全切并膀胱袖套状切除治疗上尿路移行细胞癌

目的:探讨后腹腔镜肾输尿管全切并膀胱袖套状切除治疗上尿路移行细胞癌的疗效.方法:对7例上尿路移行细胞癌患者行后腹腔镜下肾脏切除术,经同侧下腹斜切口切除输尿管肿瘤或下段输尿管并行膀胱袖套状切除,完整取出切除的肾输尿管标本.术后常规卡介苗膀胱灌注.结果:手术时间210～240 min;术中出血量80～200 ml;术后8 d出院,无严重并发症发生.随访0.5～1.5年,1例肿瘤局部复发伴肝脏转移,其余无复发.结论:后腹腔镜肾输尿管全切并膀胱袖套状切除治疗上尿路移行细胞癌,是一种安全有效的术式,具有痛苦小、并发症少及患者恢复快等优点.     

手助腹腔镜在上尿路移行细胞癌治疗中的应用

目的：探讨手助腹腔镜在肾输尿管全长切除术加膀胱袖套状切除术中的应用价值。方法：采用手助腹腔镜行肾输尿管全长切除术，加膀胱袖套状切除术治疗上尿路移行细胞肿瘤7例(其中经腹腔途径5例，经腹膜后途径2例)。病理类型均为移行细胞癌(肾盂移行细胞癌5例，输尿管移行细胞癌1例，肾盂和输尿管多发性移行细胞癌1例)。结果：7例手助腹腔镜手术均获成功。手术时间50～150min，平均97．5min；术中出血50～300ml，平均111．4ml；术后住院时间7～53d。结论：采用手助腹腔镜行肾输尿管全长切除术加膀胱袖套状切除术治疗上尿路移行细胞癌，是一种可选择的新的手术方式，与开放手术相比，具有损伤小、出血少、术后恢复快等优点。     

经尿道电切联合后腹腔镜在上尿路肿瘤手术中的应用体会

目的:探讨应用经尿道等离子电切镜联合后腹腔镜行膀胱输尿管口袖套状切除加肾输尿管全长切除术治疗上尿路移行细胞癌的可行性及安全性。方法:选取12例上尿路移行细胞癌患者,首先取截石位,应用经尿道等离子电切镜行膀胱输尿管口袖套状切除术,再改为健侧卧位采用后腹腔镜行肾输尿管切除,术中游离出输尿管中上段,最后采取麦氏点或反麦氏点切口游离输尿管下段并取出标本。术后常规行膀胱灌注化疗。结果:手术均获成功,手术时间平均(155.3±13.3)min,出血量平均(81.3±20.8)ml,术后平均(9.1±0.9)d出院,无严重并发症发生。术后随访1.5年,1例发生膀胱移行细胞癌。结论:经尿道等离子电切镜联合后腹腔镜手术治疗肾盂输尿管上尿路移行细胞癌安全、可行,具有术后康复快、手术创伤小及并发症少等优点,具有良好的应用前景。     

后腹腔镜联合应用膀胱电切镜行肾输尿管全切及膀胱袖套状切除术

目的:评价后腹腔镜联合膀胱电切镜行肾输尿管全切及膀胱袖套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10例上尿路移行细胞癌患者行后腹腔镜联合膀胱电切镜行肾输尿管全切术,完整取出切除的肾输尿管标本。术后常规化疗药物膀胱灌注。结果:手术时间180~230m in;术中出血量80~200m l;术后8d出院,无严重并发症发生。随访2~24个月,无复发。结论:后腹腔镜联合膀胱电切镜行肾输尿管全切术治疗上尿路移行细胞癌,是一种安全有效的术式,具有痛苦小、并发症少及患者恢复快等优点。     

对侧肾脏正常的上尿路移行细胞癌患者的输尿管镜治疗

对侧肾脏正常的上尿路移行细胞癌患者的标准治疗是肾输尿管全长切除术或输尿管部分切除再吻合术。对1989～1998年23例肌酐正常的患者,进行单侧上尿路移行细胞癌的经输尿管镜切除术,患者ＩＶＵ显示上尿路孤立的充盈缺损,对侧肾脏正常,输尿管镜检查为中低分级的乳头状移行细胞癌,取活检同时激光切除或电凝切除肿瘤,如果病理为高分级肿瘤,则行肾输尿管切除术。术后每3个月作一次输尿管镜检查,直到肿瘤完全消失,以后每6个月作一次输尿管镜检查。23例患者中Ｇ1～Ｇ222例,Ｇ2～Ｇ31例,治疗后肿瘤无复发8例(35%),多次复发15例(65%),仍然采用输尿管…     

Laparoscopic nephroureterectomy: long-term outcomes

PURPOSE OF REVIEW: Laparoscopic nephroureterectomy is becoming increasingly common since it was first described in 1991 for upper urinary tract transitional cell carcinoma, with long-term data now emerging. The purpose of this study was to compare oncological outcomes between laparoscopic nephroureterectomy and open nephroureterectomy, investigate recurrence risks specific to laparoscopic nephroureterectomy techniques and review long-term outcomes after laparoscopic nephroureterectomy. RECENT FINDINGS: Recently published long-term outcomes support the oncologic efficacy of laparoscopic nephroureterectomy, confirming results from previous studies with short and intermediate follow-up. Rates of bladder, local and distant recurrence are comparable irrespective of the various methods of managing the distal ureter and bladder cuff currently employed. SUMMARY: As the oncologic outcomes after laparoscopic nephroureterectomy continue to mature, a laparoscopic approach for the renal portion of nephroureterectomy is widely accepted as the gold standard in the treatment of organ-confined upper urinary tract transitional cell carcinoma. The roles of laparoscopic nephroureterectomy, lymph node dissection and adjuvant chemotherapy in advanced upper urinary tract transitional cell carcinoma continue to evolve and remain to be defined.     

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.     

Urinary tract transitional cell carcinoma and melanosis of the bladder: a case report and review of the literature

Melanosis vesica is a rare condition and thought to be benign. We report the case of a 50-year-old man who presented with haematuria and was found to have a diffusely pigmented bladder on cystoscopy and high grade transitional cell carcinoma of his upper and lower renal tract. This required a laparoscopic nephroureterectomy and pathology confirmed a diagnosis of melanosis vesica. Melanosis vesica has only been associated with high grade transitional cell carcinoma in one previous case. We recommend that any patient presenting with bladder melanosis is monitored for the development of upper or lower urinary tract transitional cell carcinoma.     

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.     

Mayo Clinic Scottsdale Experience with laparoscopic nephroureterectomy.

OBJECTIVES: To evaluate the efficacy of laparoscopic nephroureterectomy for patients with transitional cell carcinoma of the upper urinary tract. METHODS: Eighteen patients underwent attempted transperitoneal laparoscopic nephroureterectomy between June 2000 and October 2002. Mean patient age was 67.5 years. The specimen was removed intact through a 7- to 9-cm extraction incision in the lower midline. In the majority of patients, the distal ureter was dissected through the extraction incision. RESULTS: Sixteen cases were completed laparoscopically. Two cases required conversion to an open procedure. In these cases, dense fibrosis was present around the renal hilum preventing further dissection. The mean operative time was 180 minutes, and the mean estimated blood loss was 160 mL. The mean length of stay was 3.3 days. Complications included the 2 conversions, and 1 patient with a postoperative Mallory Weiss tear. No port-site or distant metastasis occurred; however, 1 patient developed a retroperitoneal recurrence. CONCLUSION: Laparoscopic nephroureterectomy is an alternative to open nephroureterectomy. Cases with high-stage and grade may cause the laparoscopic dissection to be difficult. The extraction incision allows for easy dissection of the distal ureter.     

Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience

PURPOSE: Laparoscopic nephroureterectomy has only recently been done to treat patients with upper tract transitional cell carcinoma. We retrospectively evaluated our experience with and long-term followup of laparoscopic nephroureterectomy, compared our results to those of contemporary series of open nephroureterectomy and reviewed the literature. MATERIALS AND METHODS: We reviewed the charts of and followed up by telephone 25 patients who underwent laparoscopic nephroureterectomy between May 1991 and June 1998, and 17 who underwent open nephroureterectomy between March 1990 and January 1997. Demographic, perioperative and followup data were compared. We performed a MEDLINE search and reviewed the literature on laparoscopic nephroureterectomy for upper tract transitional cell carcinoma. RESULTS: Laparoscopic nephroureterectomy required twice the operating time of open nephroureterectomy (7.7 versus 3.9 hours). However, patients who underwent the laparoscopic procedure had a 74% decrease in analgesia requirements (37 versus 144 mg. morphine sulfate equivalent), a 63% shorter hospital stay (3.6 versus 9.6 days) and a 72% more rapid convalescence (2.8 versus 10 weeks). Subsequent bladder transitional cell carcinoma and overall cancer specific survival were similar at a mean followup of 2 years. There was no sign of trocar site or peritoneal seeding after laparoscopic nephroureterectomy. CONCLUSIONS: Although laparoscopic nephroureterectomy is a longer operation, it has the same efficacy and is better tolerated by patients than open nephroureterectomy for upper tract transitional cell carcinoma. As operating time decreases due to surgeon experience and the recent development of hand assisted laparoscopy, laparoscopic nephroureterectomy may soon become the procedure of choice for the ablative management of upper tract transitional cell carcinoma.     

后腹腔镜联合经尿道电切镜治疗上尿路移行细胞癌(附83例报告)

目的 探讨后腹腔镜联合经尿道电切镜治疗上尿路移行细胞癌的效果和安全性. 方法 2003年3月～2006年7月,我院采用后腹腔镜联合经尿道电切镜治疗83例上尿路移行细胞癌.经尿道袖状电切患侧输尿管口周围1.5 cm范围膀胱壁达膀胱外脂肪组织,采用后腹腔镜切除肾及全长输尿管.术后留置导尿管7 d.11例术后辅助放疗. 结果 83例手术均成功.手术时间115～205 min,平均156 min.术中出血50～150 ml,平均80 ml.无术中并发症.术后住院7～11 d,平均8.5 d.病理报告：82例上尿路移行细胞癌,1例肾盂上皮中～重度不典型增生.术后随访3～38个月,平均10.8月.术后12个月内行膀胱镜检查发现膀胱肿瘤6例,其中5例行经尿道膀胱肿瘤电切,1例行腹腔镜根治性膀胱全切术、左侧输尿管皮肤造口术.2例肾盂肿瘤（pT3 G3和pT2 G3）于术后3个月肝转移.2例输尿管中段肿瘤（pT3 G3和pT3 G2～3）术后6个月原位复发并肺转移.1例输尿管下段肿瘤（pT3 G3）术后6个月骨转移.失访1例.其余71例均未发现肿瘤复发、切口转移及远处转移. 结论 对于上尿路移行细胞癌,采用后腹腔镜联合经尿道电切镜行肾、输尿管全切及膀胱袖套状切除具有创伤小、安全、恢复快等优点,值得临床推广应用.     

后腹腔镜联合下腹部Glison切口治疗上尿路移行细胞癌的临床价值——与同类开放性手术的对比研究

目的：回顾性比较后腹腔镜上尿路移行细胞癌根治术（LNU）与开放性上尿路移行细胞癌根治术（ONU）患者的临床资料,探讨后腹腔镜联合下腹部Glison切口治疗上尿路移行细胞癌手术的临床价值。方法：回顾性分析88例经病理检查证实的上尿路移行细胞癌患者临床资料,其中42例行LNU,46例行0Nu,采用t检验比较患者术中出血、术后恢复时间等资料,采用Kaplan—Meier法比较生存率,采用log—rank检验法比较组间生存率。结果：两组间平均手术时间差异无统计学意义,LNU组术中失血量、术后肠道恢复时间及住院时间明显少于ONU组,LNU组和ONU组5年总生存率分别为81．0％和73．7％（P=0．689）,两者之间差异无统计学意义。结论：后腹腔镜联合下腹部Glison切口治疗上尿路上皮肿瘤创伤小,安全有效,可达到与开放手术相同的肿瘤控制效果,可部分替代开放性上尿路上皮肿瘤根治术。