经尿道输尿管口及周围膀胱壁加肾输尿管切除治疗肾盂移行细胞癌.docVIP

经尿道输尿管口及周围膀胱壁加肾输尿管切除治疗肾盂移行细胞癌 作者：吴春华　师宏斌　卢冠军 【摘要】 　　目的 探讨治疗肾盂移行细胞癌的新方法及疗效。方法 总结2003年1月至2006年3月收治的12例患者的临床资料。病例均采用经尿道输尿管口及周围膀胱壁袖套状切除加腰部斜切口肾输尿管全切术。合并膀胱肿瘤及腺性膀胱炎者同期行汽化电切处理(TUEVBt)。术后1周拔除导尿管开始膀胱灌注化疗。半年一次膀胱镜检。结果 全部病例均一期愈合，无出血、感染、漏尿等并发症发生。病理证实均为肾盂移行细胞癌Ⅰ-Ⅲ级。1例术后9个月膀胱肿瘤复发行TUEVBt。现患者均健在。结论 该法操作简单，疗效好，创伤小，并发症少，恢复快，可同时处理膀胱其他疾患，是治疗肾盂移行细胞癌的良好术式。 【关键词】 尿道　肾输尿管切除术　肾肿瘤　移行性细胞 　　Transurethral excision of bladder cuff combined with retroperitoneal nephroureterectomy for transitional cell carcinoma of renal pelvis 　　ABSTRACT: Objective To study a way to treat transitional cell carcinoma of renal pelvis and evaluate the effect. Methods Clinical data of 12 cases were analysed retrospectively from Jan. 2003 to March 2006. All patients underwent transurethral excision of bladder cuff and retroperitoneal nephroureterectomy. The patients with bladder tumor or cystitis glandularis were treated by TUEVBt synchronously. One week after operation, the catheter was pulled out and intravesical chemotherapy was performed. All patients received cystoscopy every half a year. Results All patients gained onestage recovery; there were no complications such as bleeding, infection and urine leakage. The pathological results were grade Ⅰ- Ⅲ of transitional cell carcinoma of renal pelvis. 1 case recurred after 9 months and received TUEVBt. Up to now, all patients survived. Conclusion This method is advantageous to treat transitional cell carcinoma of renal pelvis owing to its simple operation, small wound, fewer complications and better effect. 　　KEY WORDS: urethra; nephroureterectomy; kidney tumor; transitional cell 　　肾盂移行细胞癌治疗传统的方法是将肾及同侧输尿管和膀胱部分切除，需要两个切口才能完成，且过程复杂。自2003年1月至2006年3月我们采用腔镜下经尿道输尿管口及周围膀胱壁袖套状切除，加腰部斜切口肾及输尿管全切除治疗该病患者12例，取得满意疗效，现报告如下。 　　1 资料与方法 　　1.1 临床资料 本组12例，男7例，女5例；年龄48-69岁；左右患侧各6例，均有无痛肉眼血尿史。合并膀胱肿瘤4例，腺性膀胱2例(术前经膀胱镜检并活检证实)，原发性高血压4例，糖尿病3例。尿脱落细胞学检查阳性2例。B超、静脉肾盂造影(IVP)或逆行肾盂造影、CT等检查均提示患侧肾盂内有充盈缺损影。 　　1.2 手术方法 采用复合麻醉。患者先取膀胱截石位。经尿道插入电切件，观察膀胱。若合并膀胱肿瘤及腺性膀胱