摘要
目的:探讨经尿道用2微米激光输尿管口袖状环切联合后腹腔镜肾输尿管全长切除术治疗肾盂尿路上皮癌的临床应用价值.方法:2008年1月～2012年12月,对38例肾盂癌患者均于全身麻醉下采用该方法治疗.先取截石位,行经尿道2微米激光输尿管口袖状环切,置入光纤后沿输尿管开口外周约0.5 cm处环形切割膀胱壁,深度达膀胱外脂肪组织,使患侧输尿管口如蘑菇头状,再以激光封闭输尿管开口,留置气囊尿管.取健侧卧位,行后腹腔镜下肾输尿管全长切除术,先行患侧肾脏根治性切除,再向远端游离输尿管全长至膀胱入口处,完整拔出远端输尿管.自切口整块取出肾输尿管全长,术后定期行表柔吡星或吡柔比星膀胱灌注治疗.结果:38例均顺利完成手术,平均手术时间126 min,平均出血量60.2 ml,术中麻醉效果满意,无并发大出血、输尿管断裂等,术后无感染及明显尿外渗.术后病理均为尿路上皮癌,其中高级别20例,低级别18例,输尿管末端均未见癌细胞浸润.平均随访18.5个月,2年疾病特异性生存率为100％,膀胱无复发率为87.1％,无远处转移发生.结论:2微米激光输尿管口袖状环切联合后腹腔镜肾输尿管全长切除法创伤小、并发症少、效果好、简单易行,符合恶性肿瘤外科治疗原则,是治疗肾盂尿路上皮癌的有效手术方法,并为上尿路肿瘤治疗中输尿管末端的处理提供了新的处理方法.
Objective:Laparoscopic retroperitoneal nephroureterectomy(LNU)is a well-established technique for managing upper urinary tract urothelial cancer.However,management of the distal ureter remains a controversial issue.We describe a new method of cystoscopic sleeve resection of the distal ureter using a 2μm continuous wave laser before LNU.Methods:We performed LNU in 38patients between Jan 2008and Dec 2012.The lower end of the ureter was managed using our new technique.We evaporated and excised the ureteric orifice with a bladder cuff using a 2μm continuous wave laser.LNU was performed using a standard technique,while leaving the ureter intact.The ureter was dissected to the entrance of bladder.Then,the distal ureter was easily detached from the bladder.Results: We achieved complete excision of the distal ureter with a bladder cuff in all cases using our new technique.The average operative time and bleeding volume was 126minutes and 60.2ml,respectively.The cause-specific patient survival rate at 2year was 100%.The bladder recurrence-free rate at 2year was 87.1%.The extravesical recurrencefree rate at 2year was 100%.Conclusions:Our new technique appears to be a simple,less invasive,and oncologically-safe method to manage the distal ureter.
出处
《微创泌尿外科杂志》
2013年第3期177-180,共4页
Journal of Minimally Invasive Urology
关键词
肾盂癌
激光
腹腔镜
urothelial cancer
laser
laparoscopy
