经尿道输尿管口环切在肾盂及输尿管癌根治术中的应用

目的探讨经尿道输尿管口环切在肾盂、输尿管癌根治术中的应用价值。方法本组13例，男性11例，女性2例，年龄45～67岁，平均54岁。肾盂癌11例，左侧5例、右侧6例。输尿管癌2例，均为右侧。合并膀胱肿瘤1例。采用先经尿道将输尿管口环状电切，然后经腰部切口行肾输尿管全切的手术方法，其中合并膀胱肿瘤1例同期行经尿道电切处理。观察手术时间、出血量、术后住院天数、并发症及手术疗效。结果13例患者手术均顺利完成。平均手术时间140min，手术平均出血量95毫升。术中无电切综合症、闭孔神经反射、大出血等并发症发生。术后留置尿管时间7～10d，术后住院时间8～11d，无尿漏发生。膀胱灌注化疗随访3月～2年，除1例患者于术后9月膀胱肿瘤复发而再次行经尿道膀胱肿瘤电切（TURBt）外，其他患者未见复发。结论该方法避免了传统手术两个切口，对病人创伤小，是治疗肾盂、输尿管肿瘤的方法之一。

Total nephroureterectomy combined with transurethral excision of the bladder cuff for renal pelvic and ureteral carcinoma

Objective To improve the surgical technique in the treatment of renal pelvic and ureteral malignancy. Methods 13 cases were analysed retrospectively from Octorber 2002 to August 2008. All patients underwent trans urethral excision of bladder cuff and retroperitoneal nephroureterectomy.The patients with bladder tumor were treated by TURBt synchronously. 7 - 10 days after operation, the catheter was pulled out and intravesical chemotherapy was performed. All patients received cystoscopy every half a year. Results The operation was successful in the whole series, lasted 110 - 190 min （av.140 min）, with blood loss averaged 95 ml （50 - 150 ml）. No serious complications were encountered after the operation. All the patients had been followed up 3 to 24 months. 1 case recurred after 9 months and received TURBt. Up to now, all patients survived. Conclusions The modified surgical technique is effective for the treatment of renal pelvic and ureteral carcinoma, causing less trauma and fewer complications and the curative effect can be increased distinctively.