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目的:探讨全腹腔镜肾输尿管全长切除技术治疗输尿管下段肿瘤的可行性、安全性和有效性。方法:对7例2012年1月~2012年12月入院输尿管下段肿瘤患者实施全腹腔镜肾输尿管全长切除术,记录围手术期参数,包括手术时间,术中出血量,住院时间,引流管的拔除时间,术后镇痛药使用时间,输尿管残端病理结果,围手术期并发症,术后随访如膀胱、手术区域肿瘤复发的情况。结果:平均手术时间126(86~160)min。1例患者腹腔镜探查下段输尿管周围粘连严重无法手术,局部取活检,放置钛夹标记术后放疗用,只行单纯肾及输尿管中上段切除。平均出血量112(20~200)ml。病理结果pT3期1例,pT2期3例,pT1期3例。无严重围手术期并发症。术后平均住院6(5~8)天。平均随访6(1~10)个月。因输尿管周围粘连未行肾输尿管全长切除的患者术后4个月死于肿瘤肺转移。其他患者未发现肿瘤复发。结论:初步的数据说明采用全腹腔镜肾输尿管全长切除术治疗输尿管下段尿路上皮癌是可行的、安全有效的。
Objective: To investigate the feasibility, safety and efficacy of total laparoscopic radical nephroureterectomy in the treatment of lower ureteral tumors. Methods: Total laparoscopic radical nephroureterectomy was performed in 7 patients with lower ureteral tumors admitted from January 2012 to December 2012. Perioperative parameters including operative time, intraoperative blood loss, length of hospital stay, drainage tube Of the time of extraction, postoperative analgesic use of time, ureteral stump pathology, perioperative complications, follow-up such as bladder, surgical tumor recurrence situation. Results: The average operation time was 126 (86-160) min. One case of laparoscopic exploration lower ureteral adhesions serious inoperable, local biopsy, placed titanium clip labeled postoperative radiotherapy, only simple upper ureter and ureter resection. The average amount of bleeding 112 (20 ~ 200) ml. Pathological results of pT3 in 1 case, pT2 in 3 cases, pT1 in 3 cases. No serious perioperative complications. The average postoperative hospital stay 6 (5 ~ 8) days. The average follow-up of 6 (1 ~ 10) months. Patients who had not had a full ureteric removal of adhesions around the ureter died of tumor lung metastases 4 months after surgery. Other patients found no tumor recurrence. Conclusion: The preliminary data indicate that total laparoscopic radical nephroureterectomy for the treatment of lower urinary tract urothelial carcinoma is feasible, safe and effective.