后腹腔镜与膀胱电切镜联合应用切除移植肾同侧自体泌尿系统肿瘤五例

目的探讨肾移植患者泌尿系统恶性肿瘤的手术方式,以减少对移植肾的干扰。方法5例尿毒症患者肾移植后发生自体肾盂和输尿管恶性肿瘤,肿瘤均位于移植肾同侧,为避免开放性手术对移植肾的干扰,采用后腹腔镜联合膀胱电切镜行自体肾、输尿管及膀胱部分切除术,手术采用3个通路完成。结果5例手术经过顺利,手术耗时120～280min,术中出血量为50～200ml。术后12～36h恢复排气,尿量为1500～4000ml/d,血肌酐正常,不必调整免疫抑制方案,平均住院4.5d。结论采用后腹腔镜联合膀胱电切镜联合切除泌尿系肿瘤,具有安全、创伤小、术后恢复快等特点,尤其是对位于移植肾同侧的肿瘤,该术式对移植肾的干扰较小。

Combined use of retroperitoneal laparoscopy and bladder resectoscope to treat renal and ureteral tumor occurring at the same side of transplanted kidney (report of 5 cases)

Objective To evaluate the operative characteristics and efficacy of retroperitoneoscopic resection of renal, ureter and partial bladder for the treatment of native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.Methods In 5 cases of renal transplantation, there were 2 cases of right native renal pelvic cancer, 1 case of right native renal (pelvic) and ureter cancer and 2 cases of right ureter cancer respectively. The transplanted kidney was in the same iliac fossa side of the tumor. All 5 patients were subjected to nephroureterectomy and bladder cuff excision by retroperitoneoscopic technique.Result Five operations were completed successfully. The operative time was 180 to 280 min, and the blood loss was 50 to 200 ml. The recovery of intestinal function after operation was 12 to 36 h. The urine output was 1 500 to 4 000 per day. Postoperative serum creatinine was still normal. The mean hospital stay after operation was 4.5 days.Conclusion Retroperitoneal laparoscopic nephroureterectomy and bladder cuff excision is a good method to treat the native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney. The procedure is safe and less invasive, which provides a good protection of transplanted (kidney).