腹腔镜手术治疗肾移植术后上尿路肿瘤的技术改进(附11例报告)

目的 探讨腹腔镜下手术治疗肾移植术后上尿路肿瘤的技术方法及临床应用价值.方法 11例肾移植术后上尿路肿瘤患者.男3例,女8例.平均年龄45岁（39～51岁）.肿瘤位于左侧4例,右侧7例;与移植肾同侧8例.采用后腹腔镜根治性肾切除联合经尿道膀胱袖套状切除术,手助处理输尿管下段,标本自腰部小切口取出.观察手术时间、术中出血量、住院天数、并发症及手术效果.结果 11例平均手术时间150 min（90～190 min）,术中平均出血量100ml（50～200ml）,术后平均住院时间10 d（9～12 d）,术中术后均未发生严重并发症.随访2～16个月,肿瘤无复发及远处转移.术后移植肾功能良好.结论 腹腔镜辅以手助处理输尿管末段治疗肾移植术后上尿路肿瘤效果良好,具有临床推广价值.

Modified techniques of laparoscopy for the treatment of upper urinary tract tumor in renal allograft recipients (report of 11 cases)

Objective To evaluate the surgical techniques and clinical efficacy of laparoscopy forthe treatment of upper urinary tract tumor in renal allograft recipients. Methods A total of 11 patients (3men and 8 women;mean age,45 years;age range,39 -51 years) with upper urinary tract tumor after renaltransplantation were treated with retroperitoneoscopic radical nephrectomy and transurethral cuffing cystecto-my.The tumors were located on the left side in 4 cases and on the right in 7.Among the 11 patients,8 hadthe tumors on the same side with the renal allografts.During the operation in lower ureter,hand-assistedmethod was used.The intraoperative and postoperative data,including operative time,blood loss/transfusionrate, complications,hospital stay were recorded. Results The mean operative time was 150 min(range,90 -190 min),mean blood loss was 100 ml(range,50 -200 ml)and mean hospital stay was 10 d (range,9 -12 d).There was no serious complication during and after operation.Follow-up was 2 -16 months.Notumor recurrence and metastasis were observed.The renal function of the allografts was normal in all the 11patients. Conclusions Laparoscopy with hand-assisted method for handling distal ureter produces satis-factory results for the treatment of upper urinary tract tumor in renal allograft recipients.It can be used widelyin clinical practice.