Ye Jian-fei, Ma Lu-lin, Huang Yi, Xiao Chun-lei, Hou Xiao-fei, Zhao Lei, Wang Guo-liang, Lu Jian, Hong Kai, Tian Xiao-jun
Department of Urology, Peking University Third Hospital, Beijing, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2012 Aug 18;44(4):639-42.
To present the preliminary experience of the operative procedure and clinical outcomes of retroperitoneal laparoscopic nephroureterectomy (RPLNU) with a midline lower abdominal transperitoneal incision for native upper urinary tract transitional cell carcinoma (UUT-TCC) ipsilateral to a transplanted kidney.
In the study, 15 renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated on with RPLNU via a midline lower abdominal transperitoneal incision between November 2005 and January 2009. Retroperitoneal laparoscopic nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6-8 cm midline lower abdominal incision was made. The distal ureter was dissected transperitoneally into the intramural segment and extracted completely. The intact specimen was removed manually via the same incision. The cystostomy was generally sutured.
The mean operation time was 253 minutes. The mean estimated blood loss was 245 mL. Three patients needed blood transfusion. No open conversion was required during the retroperitoneoscopic nephrectomy. Two of the patients suffered from minor complications. The pathological findings confirmed UUT-TCC in all the patients with 9 of the pelvises and 9 of the ureters. Five of the patients were involved with bladder TCC. With the mean follow-up of 35 months, none of them had retroperitoneal recurrence or distant metastasis, 2 of the 5 patients with bladder TCC had recurrence in bladder and 4 had contralateral native UUT-TCC after the first unilateral nephroureterectomy.
RPLNU with a midline lower abdominal transperitoneal incision may be a safe and feasible alternative for native UUT-TCC ipsilateral to a transplanted kidney with satisfactory oncologic outcomes.
介绍经下腹正中经腹切口行腹膜后腹腔镜肾输尿管切除术（RPLNU）治疗移植肾同侧原发性上尿路移行细胞癌（UUT-TCC）的手术操作初步经验及临床疗效。
本研究中，2005年11月至2009年1月期间，15例移植肾同侧原发性UUT-TCC患者经下腹正中经腹切口行RPLNU手术。先进行腹膜后腹腔镜肾切除术，然后经膀胱镜切除同侧输尿管口及膀胱袖口组织。在下腹部正中做一个6-8cm的切口。经腹膜将远端输尿管游离至壁内段并完整取出。通过同一切口手动取出完整标本。膀胱造口一般予以缝合。
平均手术时间为253分钟。平均估计失血量为245ml。3例患者需要输血。腹膜后腹腔镜肾切除术中无需中转开放手术。2例患者出现轻微并发症。病理检查证实所有患者均为UUT-TCC，肾盂9例，输尿管9例。5例患者合并膀胱TCC。平均随访35个月，无一例出现腹膜后复发或远处转移，5例膀胱TCC患者中有2例膀胱复发，4例在首次单侧肾输尿管切除术后对侧原发性UUT-TCC。
经下腹正中经腹切口行RPLNU治疗移植肾同侧原发性UUT-TCC可能是一种安全可行的选择，肿瘤学疗效满意。
