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目的:探讨后腹腔镜肾输尿管全长与膀胱袖状切除的最佳手术方式。方法:对110例肾盂或输尿管癌伴膀胱癌患者采用三种不同术式行肾输尿管全长及膀胱袖状切除术:A术式即后腹腔镜肾输尿管全长切除+下腹部切口膀胱壁内段袖状切除术,共行32例;B术式即后腹腔镜肾输尿管全长切除+经尿道电切膀胱袖状切除+经腹部切口取肾术,共行19例;C术式即经尿道电切膀胱袖状切除+后腹腔镜肾输尿管全长切除+经腹部切口取肾术,共行59例。结果:手术经过均顺利。三种术式的手术时间、术中出血量、平均住院时间差异无统计学意义。围手术期死亡3例。出院后获定期随访58例,随访8～85个月,平均38.3个月,46例失访。因肿瘤转移死亡4例,因气胸、脑血管病死亡各1例。三种术式术后早期并发症、对侧病变、膀胱癌复发情况差异无统计学意义;但C术式术后死亡及转移例数较少。结论:肾盂或输尿管癌伴膀胱癌者可优先选择经尿道电切膀胱袖状切除+后腹腔镜肾输尿管全长切除+经腹部切口取肾术,而仅有肾盂或输尿管癌者可考虑行后腹腔镜肾输尿管全长切除+下腹部切口膀胱壁内段袖状切除术。
Objective: To explore the best laparoscopic renal ureter and bladder sleeve resection of the best surgical approach. Methods: 110 cases of renal pelvis or ureter cancer with bladder cancer were treated with three different methods of total length of the ureter and bladder sleeve resection: A type of retroperitoneal laparoscopic radical nephroureterectomy + lower abdominal incision in the bladder wall Section sleeve sleeve resection, a total of 32 cases; B-type retroperitoneal laparoscopic radical nephroureterectomy + transurethral resection of the bladder sleeve + abdominal transcervical nephrectomy, a total of 19 cases; C surgery that is Transurethral cyst excision + retroperitoneal laparoscopic radical nephroureterectomy + transabdominal incision and kidney surgery, a total of 59 cases. Results: The procedure went well. There was no significant difference in operation time, intraoperative blood loss and average length of stay between the three surgical procedures. Perioperative death in 3 cases. After discharge, 58 patients were followed up for a period of 8 to 85 months with an average of 38.3 months and 46 patients were lost to follow-up. 4 died of tumor metastasis, 1 died of pneumothorax and cerebrovascular disease. There were no significant differences in the early complications, the contralateral lesions and the recurrence of bladder cancer among the three surgical procedures. However, the number of postoperative deaths and metastases was less in the three surgical procedures. Conclusion: The renal pelvis or ureteral cancer with bladder cancer may be the preferred choice of transurethral resection of bladder sleeve resection + retroperitoneal laparoscopic radical nephroureterectomy + transabdominal incision to take kidney surgery, and only the renal pelvis or ureteral cancer may consider the line Laparoscopic nephroureterectomy + lower abdominal incision Bladder resection of bladder wall.