后入路腹腔镜联合经尿道电切手术治疗肾盂癌

目的探讨后腹腔镜手术联合经尿道电切治疗肾盂癌的手术方法及其临床效果。方法18例肾孟癌患者采用后腹腔镜联合经尿道电切,行肾输尿管全切加膀胱输尿管口袖套状切除。手术应用Olympus腹腔镜(30°或0°),气管插管全麻。切口位于腋中线与髂嵴上缘2 cm相交处,长10 mm。以自制水囊(充水250～300 ml)撑开腹膜后间隙,然后取出水囊,注入CO2气体,建立气腹,插入腹腔镜进行操作。术中电凝止血,不做膀胱冲洗。18例患者病理诊断均为肾盂移行细胞癌Ⅱ～Ⅲ级,病理分期为T1N0M0～T2N0M0。结果18例患者手术均获成功。手术时间150～190 min,平均160 min。住院时间7～10 d,术后无并发症。术后随访1～19个月,无肿瘤复发及转移,无切口肿瘤种植。结论后腹腔镜手术联合经尿道电切治疗肾盂癌具有创伤小,解剖清晰,术中出血少,术后恢复快等优点。

Retroperitoneal laparoscopy combined with urethral resection for treatment of renal pelvic carcinoma

OBJECTIVE: The purpose of this study is to explore the operation method and efficacy through retroperitoneal laparoscopy combined with urethral resection for treatment of renal pelvic carcinoma. METHODS: Total nephroureterectomy with excision of bladder cuff by retroperitoneal laparoscopy plus urethral resection was performed in 18 patients with pathologically confirmed pelvic transitional cell carcinoma (II-III, T1N0M0-T2N0M0). The operation was performed using Olympus celioscope (30 degrees or 0 degree) under general anesthesia. First, a 10 mm incision was made at the intersection of midaxillary line and superior border 2 cm from crista iliaca, then a self-made hyponome filled with 250-300 ml water was put through the small incision in order to open the retroperitoneal space, followed by getting the hyponome out and perfusing CO2 into the retroperitoneal space to make a pneumoretroperitoneum. Finally, the celioscope was put into the retroperitoneal space to operate. During the operation, electric coagulation was used to stop bleeding and the bladder was not irrigated. RESULTS: The operation was successfully performed in 18 patients without any complication. The operative time ranged from 150 to 190 min with a mean of 160 min. The hospital stay after operation was 7 to 10 days. There was no tumor recurrence or metastasis or implantation in all these patients after follow-up of 1-19 months. CONCLUSION: Compared with regular operation mode, retroperitoneal laparoscopy plus urethral resection for treatment of renal pelvic carcinoma is a minimally invasive treatment with less bleeding and quick recovery.