腹膜后腹腔镜治疗肾盂及输尿管肿瘤

目的：总结后腹腔镜治疗肾盂及输尿管肿瘤的临床经验。方法：采用后腹腔镜技术切除肾脏,采用患侧下腹切口取出肾标本,并向下行输尿管及膀胱袖状切除。结果：本组25例手术顺利,无1例中转开放手术,手术时间2.5~4 h,平均3 h。出血量60~200 ml,平均100 ml,术中无1例输血。术后24~48 h下床活动。术后病理报告：25例均为移行上皮癌。术后平均住院时间9 d。术后常规行膀胱灌注化疗,定期膀胱镜检查。21例获随访,随访时间6~33个月,其中1例肾盂癌术后6个月发生膀胱癌,2例输尿管癌术后分别于18个月,23个月发生膀胱癌,均行TURBT治愈。1例输尿管下段癌术后26个月盆腔转移,行放射治疗。目前随访21例均存活,20例无瘤存活,1例带瘤存活。结论：腹膜后腹腔镜治疗肾及输尿管肿瘤,患者创伤小,疼痛轻,术后恢复快,目前已成为泌尿外科医生主要的手术方法。

Treatment of Renal Pelvic and Ureteral Tumors by Retroperitoneal Laparoscopy

Objective： To report our experience with retroperitoneal laparoscopy with treatment of renal pelvic and ureteral tumors. Methods： Exieision of kidney by retroperitoneal laparoseopy ;then an incision was created in lower abdomen toallow dissection of the distal ureter and bladder- cuff and intact specimen extrac- tion. Results：25 cases performed successfully. The average duration of operation was 3 h （varied between 2. 5- 4h）, the average volume of bleeding was 100 ml（varied between 60-200 mI）. Postoperative pathology showed transitional cell carcinoma in 25 cases . The patients activity recovered in 24 - 48 h of the operation. The mean hospital stay was 9 days . Postoperative vesical irrigation was performed. 21cases were followed up between 6 - 33 months, 1 patient developed pelvic metastasis and was alive with the tumor. The other 20 patients survived free of tumorto date. 2 patients had recurrent transitional cell carcinoma of bladder. Conclusions- Our data demonstrate that retroperitoneoscopic nephroureterectomy for venal pelvic and ureteral tumors has shorter inci- sion and more rapid postoperative vecovery compared with open surgery. Retroperitoneoscopic nephrouretereetomy with bladder - cuff excision can be selected surgical treatment for renalpelvic and ureteral tumors.