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目的:探讨全腹腔镜下一期全泌尿道切除术(TUTE)治疗维持血液透析患者多发尿路上皮肿瘤的可行性和安全性。方法:2例维持血液透析并发泌尿系多发尿路上皮肿瘤的女性患者行全腹腔镜一期TUTE,手术范围包括双侧肾脏输尿管全长切除、根治性膀胱切除及盆腔淋巴结清扫。标本经阴道或下腹Pfannenstiel切口完整取出,结合文献对其临床资料进行分析。结果:2例患者手术均顺利完成,无术中、后严重并发症的发生。手术时间分别为345min、410min,术中出血量分别为480ml、650ml,2例患者分别于术后2天、3天恢复正常饮食。1例患者术后出现腹腔淋巴瘘,经充分引流2周后消失。患者术后恢复良好,分别随访19个月、11个月,未见肿瘤复发和转移。结论:若一般情况许可,腹腔镜下一期TUTE治疗血液透析患者多发尿路上皮肿瘤安全可行。
Objective: To investigate the feasibility and safety of total laparoscopic total urotomy (TUTE) in the maintenance of multiple urothelial tumors in hemodialysis patients. Methods: Two patients undergoing hemodialysis combined with multiple urothelial tumors of the urinary tract underwent a total laparoscopic TUTE. The surgical range included bilateral total ureter removal, radical cystectomy and pelvic lymph node dissection. The specimens were completely removed via vaginal or abdominal Pfannenstiel incision, and their clinical data were analyzed according to the literature. Results: The operation of 2 patients was successfully completed without serious intraoperative and postoperative complications. The operative time was 345min and 410min respectively. The intraoperative blood loss was 480ml and 650ml respectively. Two patients returned to normal diet on the 2nd and 3rd days respectively. One patient had abdominal lymphatic fistula after operation and disappeared after 2 weeks of full drainage. Patients recovered well, were followed up for 19 months, 11 months, no tumor recurrence and metastasis. CONCLUSIONS: Laparoscopic TUTE treatment of multiple urothelial tumors in hemodialysis patients is safe and feasible if the general situation permits.