论文部分内容阅读
目的:介绍后腹腔镜肾输尿管切除术结合经腹腔下腹正中切口治疗移植肾同侧原上尿路移行细胞癌的最初经验。方法:选取2005年11月至2009年1月间,北京大学第三医院15例肾移植后因移植肾同侧原上尿路移行细胞癌而接受结合经腹腔下腹正中切口的后腹腔镜肾输尿管切除术的患者。后腹腔镜下将肾切除后,经膀胱镜行同侧输尿管口及膀胱袖状切除术,于下腹正中做6～8 cm切口,经腹腔途径将远端输尿管切至膀胱壁内段后,将输尿管完整取出,并经此切口完整取出标本。结果:平均手术时间为253 min,平均术中出血245 mL,3例患者接受输血治疗。后腹腔镜肾切除术中无1例中转开放,2例患者出现轻微并发症。病理结果显示:3例肾盂、1例肾盂和输尿管、3例肾盂和膀胱、1例双侧肾盂、4例输尿管、2例输尿管和膀胱和1例双侧输尿管内可见移行细胞癌。平均随访35个月,无1例患者后腹腔内复发或远处转移。5例并发膀胱癌患者中在随访时发现有2例复发膀胱癌,4例行单侧肾输尿管切除的患者在随访中发现对侧原上尿路移行细胞癌。结论:后腹腔镜肾输尿管切除术结合下腹正中经腹腔切口的方法可能是一个治疗移植肾同侧原上尿路移行细胞癌的安全且有效的选择。
OBJECTIVE: To introduce the experience of retroperitoneal laparoscopic nephroureterectomy combined with transabdominal median incision in the treatment of transplanted renal ipsilateral upper urinary tract transitional cell carcinoma. Methods: From November 2005 to January 2009, 15 cases of the third hospital of Peking University were retrospectively analyzed retrospectively. After laparoscopic nephroureterectomy combined with the transabdominal median mesial incision Excision of patients. After laparoscopic resection of the kidneys, the cystoscopy ipsilateral ureter and bladder sleeve resection in the middle of the abdomen to do 6 ~ 8 cm incision, the distal ureter was cut into the bladder wall by intraperitoneal route, the Complete removal of the ureter, and after this incision completely remove the specimen. Results: The average operation time was 253 min. The mean intraoperative bleeding was 245 mL. Three patients received blood transfusion. No retroperitoneal laparoscopic nephrectomy in 1 case turned open, 2 patients had minor complications. The pathological results showed that 3 cases of renal pelvis, 1 case of renal pelvis and ureter, 3 cases of renal pelvis and bladder, 1 case of bilateral renal pelvis, 4 cases of ureter, 2 cases of ureter and bladder and 1 case of bilateral ureter showed transitional cell carcinoma. After a mean follow-up of 35 months, none of the patients had intra-abdominal recurrence or distant metastasis. Two patients with recurrent bladder cancer were found in 5 patients with concurrent bladder cancer at follow-up, and 4 patients with unilateral ureteropelvic resection found contralateral primary urinary tract transitional cell carcinoma at follow-up. Conclusions: Retroperitoneal laparoscopic nephroureterectomy combined with transabdominal median abdominal incision may be a safe and effective method for the treatment of transplanted renal ipsilateral upper urinary tract transitional cell carcinoma.