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目的:探讨经尿道用2微米激光输尿管口袖状环切联合后腹腔镜肾输尿管全长切除术治疗肾盂尿路上皮癌的临床应用价值。方法:2008年1月~2012年12月,对38例肾盂癌患者均于全身麻醉下采用该方法治疗。先取截石位,行经尿道2微米激光输尿管口袖状环切,置入光纤后沿输尿管开口外周约0.5cm处环形切割膀胱壁,深度达膀胱外脂肪组织,使患侧输尿管口如蘑菇头状,再以激光封闭输尿管开口,留置气囊尿管。取健侧卧位,行后腹腔镜下肾输尿管全长切除术,先行患侧肾脏根治性切除,再向远端游离输尿管全长至膀胱入口处,完整拔出远端输尿管。自切口整块取出肾输尿管全长,术后定期行表柔吡星或吡柔比星膀胱灌注治疗。结果:38例均顺利完成手术,平均手术时间126min,平均出血量60.2ml,术中麻醉效果满意,无并发大出血、输尿管断裂等,术后无感染及明显尿外渗。术后病理均为尿路上皮癌,其中高级别20例,低级别18例,输尿管末端均未见癌细胞浸润。平均随访18.5个月,2年疾病特异性生存率为100%,膀胱无复发率为87.1%,无远处转移发生。结论:2微米激光输尿管口袖状环切联合后腹腔镜肾输尿管全长切除法创伤小、并发症少、效果好、简单易行,符合恶性肿瘤外科治疗原则,是治疗肾盂尿路上皮癌的有效手术方法,并为上尿路肿瘤治疗中输尿管末端的处理提供了新的处理方法。
Objective: To investigate the clinical value of transurethral resection combined with retroperitoneal laparoscopic radical nephroureterectomy with 2 μm laser ureteropelvic sleeve for the treatment of renal pelvic urothelial carcinoma. Methods: From January 2008 to December 2012, 38 patients with renal pelvic cancer underwent general anesthesia. First take the lithotomy position, transurethral 2-meter laser ureteropelvic sleeve loop, placed in the optical fiber along the ureteral orifice around the outer circumference of about 0.5cm at the annular bladder wall, the depth of extra-adipose tissue, the ipsilateral ureteral orifice mushroom head , And then closed the ureter laser opening, leaving the balloon catheter. Take the healthy lateral position, after laparoscopic radical nephroureterectomy, the first ipsilateral kidney radical resection, and then to the distal free ureter full length to the entrance to the bladder, the complete pull out of the distal ureter. Whole kidney ureter removed from the incision the whole length of the line after surgery regularly on the line of Doxipu or pirarubicin bladder irrigation treatment. Results: All the 38 cases were successfully performed. The average operation time was 126 minutes and the average amount of bleeding was 60.2ml. The anesthesia was satisfactory, no complicated hemorrhage and ureter rupture, and no postoperative infection and obvious extravasation. Postoperative pathology was urothelial carcinoma, of which 20 cases of high grade, 18 cases of low grade, no end of the ureter cancer cell infiltration. With an average follow-up of 18.5 months, the 2-year disease-specific survival rate was 100%, and the rate of bladder recurrence was 87.1% without distant metastasis. Conclusions: The 2-μm laser ureteropelvic ring combined with retroperitoneal laparoscopic radical nephroureterectomy has the advantages of less trauma, less complications, better curative effect, simple and easy operation, in line with the principle of surgical treatment of malignant tumors, and is the treatment of renal pelvic urothelial carcinoma Effective surgical methods, and provide a new treatment for the treatment of ureteral terminals in the treatment of upper urinary tract tumors.