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目的:探讨CO2气膀胱经尿道电切处理膀胱袖套—输尿管下段在上尿路尿路上皮癌根治术中的临床应用价值。方法:采用CO2气膀胱对18例肾盂、输尿管癌患者行膀胱袖套-输尿管下段切除。其中13例为肾盂癌,5例为上段输尿管癌。观察手术时间、术中出血量、并发症、手术效果,收集随访资料。结果:18例手术均顺利完成,平均电切手术时间为15 min(9~20 min),电切术中平均出血4.5 ml(2~10 ml),末端管壁电凝变性而封闭,术中术后无并发症发生。术后输尿管末端病检未见癌细胞,所有病例随访6~40个月,其中1例高级别尿路上皮癌患者术后1年在远离瘢痕处再发膀胱癌,所有病例膀胱外间隙均未见肿瘤种植转移。结论:CO2气膀胱经尿道电切处理膀胱袖套-输尿管下段,符合肿瘤学无瘤操作的治疗原则,安全有效,是一种输尿管下段及膀胱袖状切除的新方法。
OBJECTIVE: To investigate the clinical value of transurethral resection of bladder cuff with CO2 gas bladder transurethral electrovaporization for the treatment of lower urinary tract urothelial carcinoma under radical surgery. Methods: Eighteen patients with renal pelvis and ureter cancer underwent cuff-ureter resection with CO2 gas bladder. Among them, 13 cases were renal pelvis cancer and 5 cases were upper ureteral carcinoma. Observation of operation time, intraoperative blood loss, complications, surgical results, follow-up data collection. Results: All the 18 surgeries were completed successfully. The mean duration of resection was 15 min (9-20 min). The mean bleeding time was 4.5 ml (2-10 ml) during the resection. The distal end of the wall was closed by electrocoagulation. No postoperative complications. All the cases were followed up for 6 to 40 months. One case of high-grade urothelial carcinoma recurred bladder cancer away from the scar one year after operation, and none of the cases had an out-of-bladder space See tumor metastasis. CONCLUSION: CO2 gas bladder transurethral resection of bladder cuff - the ureter, in line with the principle of tumor-free operation of the treatment, safe and effective, is a lower ureter and bladder sleeve resection of a new method.