全腹腔镜根治性肾输尿管全长切除术治疗肾移植术后上尿路肿瘤

目的：评价全腹腔镜根治性肾输尿管全长切除术治疗肾移植术后上尿路移行细胞癌的有效性和安全性。方法：回顾性分析2008年1月～2011年9月收治13例肾移植术后并发上尿路肿瘤患者资料，男3例，女10例，年龄32～64岁，肾移植术后18～65个月，行全腹腔镜根治性肾输尿管全长切除16次（3例为先后双侧发生）。4例次肿瘤与移植肾位于同侧（其中2例有剖宫产和子宫切除等下腹部手术史）。先行经尿道用针形电极环绕输尿管管口行袖套状切除，再改变体位行腹膜外途径全腹腔镜根治性肾输尿管全长切除术。下段输尿管在腔镜直视下分离至髂总血管分叉以下，并记录其有关指标。结果：16例次手术均成功，手术时间120～230min，平均178min；术中出血量20～260ml，平均80ml；术后住院时间11～16d，平均12．5d。13例随访3～48个月，无腹膜后肿瘤复发，1例膀胱内新发肿瘤。无远处转移及穿刺通道的种植性转移。结论：腹膜后途径全腹腔镜根治性肾输尿管全长切除术治疗。肾移植后上尿路移行细胞癌是安全、有效的微创手术方法，但其对肿瘤细胞生物学行为的影响尚需作进一步的评价。

Totally retroperitoneoscopic nephroureterectomy for upper tract transitional cell carcinoma post renal transplantation

Objective：To evaluate the efficacy and safety of the totally retroperitoneoscoplc nephrOureterectomy for upper tract of transitional cell Carcinoma post renal transplantation. Method： From January 2008 to September 2011, 16 cases （3 males, 10 females, bilateral tumors occurred in 3 cases, 32-64 years old） retroperitoneoscopic nepbroureterectomY for upper tract of transitional cell carcinoma post renal transplantation were performed. The tumor were diagnosed 18-65 months after renal transplantation. After excision of bladder cuff with resectoscope, totally retroperitoneal laparoscopic radical nephroureterectomy were performed. The ureter was divided below the furcation of common lilac artery by laparoscope. Result：Sixteen cases succeeded uneventfully. The mean operation time was 178 （120-230） min, and the estimated blood loss was 80 （20-260） ml with no need of blood transfusion. The mean postoperative hospital stay was 12.5 （11-16） days. There was no serious complication in perioperative and postoperative period. One case of bladder tumor occurred de novo after follow-up of 3-48 months in i3 cases. Conelusion：Retroperitoneal laparoscope combine resectoscope in radical nephroureterectomy for upper tract transi tional cell carcinoma post renal transplataion is an effective and safe microinvasive surgery, which will have good prospect in the urologic clinical practice.