后腹腔镜联合经尿道输尿管口电切治疗上尿路尿路上皮癌

目的探讨后腹腔镜联合经尿道输尿管口电切行上尿路尿路上皮癌（upper urinary tract urothelial carcinoma，UUT—UC）根治性切除术的疗效。方法2009年4月～2012年1月，对21例UUT—UC采用后腹腔镜联合经尿道输尿管口电切行肾、输尿管、膀胱袖状切除术。先经尿道行输尿管口电切使输尿管与膀胱完全脱离，后腹腔镜下行肾及上段输尿管的游离和切除，取标本同时游离中下段输尿管以完成全程输尿管的切除。结果21例手术均成功，手术时间80～150min，平均110min，术中出血量60～180ml，平均100ml；无严重并发症发生。术后住院8～14d，平均9．5d。病理检查均为UUT—UC，其中肾盂癌15例，输尿管癌6例，20例T1-2N0M0，1例T3N0M0。21例随访4～36个月，平均20个月，均未见肿瘤复发及转移。结论后腹腔镜手术联合经尿道输尿管口电切治疗低级别肾盂癌和上段输尿管癌安全、有效。

Retroperitoneal Laparoscopy Combined with Transurethral Resection of the Ureteral Orifice for Upper Urinary Urothelial Carcinoma

Objective To evaluate retroperitoneal laparoscopy combined with transurethral resection of the ureteral orifice for the treatment of upper urinary tract urothelial carcinoma （UUT-UC）. Methods A retrospective analysis on 21 patients with UUT-UC, who underwent transurethral resection of the ureteral orifice with bladder cuff. Electrie resection of the ureteral orifice was performed through the transurethral approach to separate the ureter from the bladder, and then the kidney and upper ureter were separated and removed by retroperitoneal laparoscopy. While removing the specimen, the middle and lower ureter was separated as well. Results The procedure was completed in all the 21 cases within 80 to 150 rain with a mean of 110 rain. The mean intraoperative blood loss was 100 ml （ranged from 60 to 180 ml）. No severe complications occurred during the procedure. The patients were discharged from hospital in 8 to 14 days （mean, 9.5 days） after the operation. Postoperative pathological examination showed renal pelvis carcinoma in 15 patients, and ureteral carcinoma in 6; 20 of them were at stage T1-2N0M0, while the other was at stage T3 N0 M0. The patients were followed up for 4 to 36 months with a mean of 20 months; none of them had recurrence or metastasis during the period. Conclusion Retroperitoneal laparoseopy combined with transurethra] resection of the ureteral orifice is safe and effective for early stage renal and upper ureteral carcinoma.