目的:探讨高危肾盂癌患者的治疗方法。方法:自2009年7月~2012年12月对14例高龄且伴有严重并发症的肾盂癌患者行经腹膜后途径腹腔镜下肾脏+中上段输尿管切除术,术后正规膀胱灌注表柔比星注射液,以预防再发膀胱癌,并定期进行影像学及膀胱镜检查。结果:14例手术全部成功,手术时间63~105min,平均78.3min。术后24~48小时恢复饮食,5~9天出院。术后病理检查2例为鳞状细胞癌,12例为尿路上皮细胞癌;其中2例为浸润性肾盂癌伴肾门处淋巴结转移。术后13例得到随访,1例失访;随访8~36个月,平均21.4个月。1例术后13个月死于肺部转移,2例术后21个月因心肺疾病死亡;2例术后再发膀胱癌,行根治性全膀胱切除。结论:对于高危肾盂癌患者,简化手术,腹腔镜下切除肾脏+中上段输尿管,术后配合正规膀胱灌注化疗是一种有效安全的治疗方法。 Objective: To explore the treatment of high-risk renal pelvic cancer patients. Methods: From July 2009 to December 2012, 14 patients with renal pelvic cancer with advanced complications underwent retroperitoneal laparoscopic nephroureterectomy and ureteropelvic excision. The regular intravesical instillation of epirubicin Injection to prevent the recurrence of bladder cancer, and regular imaging and cystoscopy. Results: All the 14 surgeries were successful. The operation time was 63-105 minutes with an average of 78.3 minutes. After 24 to 48 hours to resume diet, 5 to 9 days discharged. Postoperative pathological examination of 2 cases of squamous cell carcinoma, 12 cases of urothelial carcinoma; 2 cases of invasive renal pelvic cancer with renal portal lymph node metastasis. Thirteen patients were followed up and one lost follow-up. The patients were followed up for 8 to 36 months with an average of 21.4 months. One patient died of lung metastasis at 13 months after operation, two died of cardiorespiratory disease at 21 months after operation. Two patients had recurrent bladder cancer after radical resection of the whole cystectomy. Conclusion: For patients with high-risk renal pelvic cancer, simple operation, laparoscopic removal of the kidney + upper ureter, and regular postoperative chemotherapy with bladder irrigation is an effective and safe treatment.