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经腹入路一站式腹腔镜肾脏-输尿管-膀胱袖状切除术治疗上尿路尿路上皮癌的临床研究

Complete transperitoneal laparoscopic nephroureterectomy with bladder-cuff excision for upper tract urothelial cancer:one-station technique without patient repositioning
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摘要 目的:探讨完全腹腔镜下经腹入路一站式肾脏-输尿管-膀胱袖状切除术治疗上尿路尿路上皮癌(UTUC)的手术技巧和临床效果。方法:2015年2月~2018年5月我院通过影像学检查或输尿管镜活检确诊的17例UTUC患者行完全腹腔镜下经腹入路一站式肾脏-输尿管-膀胱袖状切除手术。采取健侧60°卧位,放置5个Trocar,先行患侧根治性肾切除,然后沿输尿管向下游离至输尿管膀胱入口处,再将输尿管开口周围膀胱壁作袖状切除,缝闭膀胱切口。结果:17例手术均获成功,无中转开放,手术时间110~150min,平均125min;术中出血80~200ml,平均120ml;术后住院6~14d,平均8d;术后漏尿1例,引流后自愈。术后随访6~45个月,其中术后漏尿患者于术后9个月发现对侧输尿管口周围尿路上皮癌复发,行经尿道膀胱肿瘤电切术(TURBt),随访至今未见复发;失访3例,其余病例未见术中术后并发症,未见肿瘤复发及转移。结论:经腹入路一站式腹腔镜肾脏-输尿管-膀胱袖状切除术治疗UTUC安全可行,术中无需变换体位就能完成从肾脏到输尿管全段和膀胱袖状切除,是一种值得推广的手术方法。 Objective:To describe one-station technique of complete transperitoneal laparoscopic nephroureterectomy with bladder-cuff excision for treatment of upper tract urothelial cancer(UTUC).Method:Between February 2015 and May 2018,17 cases diagnosed with UTUC underwent complete transperitoneal laparoscopic nephroureterectomy with bladder-cuff excision.After finishing the transperitoneal laparoscopic nephrectomy in a60°recumbent position,an additional 5-mm(right side)or 12-mm trocar(left side)was inserted at the lower abdomen to continue dissecting the distal ureter and complete the bladder-cuff excision without repositioning the patient during the procedure.Result:All the operations were successful.The mean operative time was 125(range,110-150)min,the mean blood loss was 120(range,80-200)ml and the mean hospitalization time was 8(range,6-14)days.The postoperative follow-up time ranged from 6 to 45 months(3 cases lost to follow-up),one case suffered from urine leakage after surgery and had a bladder recurrence 9 months postoperatively.No serious complications occurred and no tumor recurrence or metastasis occurred in other cases.Conclusion:One-station complete transperitoneal laparoscopic nephroureterectomy with bladder-cuff excision is a safe and reliable operation for UTUC,with the advantages of no need repositioning during the procedure.
作者 徐玉节 候腾 李兵 海波 肖行远 杨雄 潘求丰 孙琳 张浩 梁超启 陈朝晖 邢毅飞 赵军 肖亚军 章小平 XU Yujie;HOU Teng;LI Bing;HAI Bo;XIAO Xingyuan;YANG Xiong;PAN Qiufeng;SUN Lin;ZHANG Hao;LIANG Chaoqi;CHEN Zhaohui;XING Yifei;ZHAO Jun;XIAO Yajun(Department of Urology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China;Department of Urology,Yijishan Hospital,Wannan Medical College)
出处 《临床泌尿外科杂志》 2019年第2期109-112,共4页 Journal of Clinical Urology
关键词 上尿路尿路上皮癌 经腹腔途径 腹腔镜 肾脏输尿管切除 膀胱袖状切除 upper tract urothelial cancer transperitoneal laparoscope nephroureterectomy bladder-cuff excision
作者简介 通信作者:李兵,E-mail:Bingli@hust.edu.cn
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