Chen I-Hsuan, Lin Jen-Tai, Tsai Jeng-Yu, Wu Tony, Yu Chia-Cheng
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan ; Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan.
Biomed Res Int. 2014;2014:649642. doi: 10.1155/2014/649642. Epub 2014 Aug 11.
To present our experience with single mini-incision complete urinary tract exenteration (CUTE) for female dialysis patients suffering from urothelial carcinoma (UC).
Institutional review board approval was obtained. From 2005 through 2012, 14 female dialysis patients with UC underwent single mini-incision CUTE, in combination with radical hysterectomy and bilateral salpingo-oophorectomy. All were placed in the modified dorsal lithotomy position without repositioning. An infraumbilical midline mini-incision was made. Bilateral nephroureterectomy was first performed entirely extraperitoneally, followed by radical cystectomy with removal of the uterus and ovaries transperitoneally.
All procedures were done successfully without major complications. The median operative time was 242.5 minutes, and estimated blood loss was 500 mL. The median time to oral intake was 2 postoperative days; the median hospital stay was 11 days. Ten patients remained cancer-free at a median follow-up of 46.5 months; six patients were confirmed as having preoperatively undetectable UC or renal cell carcinoma, even after reviewing preoperative computed tomography.
This modified technique provides a time-saving complete urinary tract extirpation to eliminate preoperatively undetectable malignancy, reduce metachronous recurrences, and avert perioperative complications associated with pneumoperitoneum and repositioning. Good cancer control and early convalescence can mutually be achieved in experienced hands.
介绍我们对患有尿路上皮癌（UC）的女性透析患者进行单小切口全尿路切除术（CUTE）的经验。
获得机构审查委员会批准。2005年至2012年，14例患有UC的女性透析患者接受了单小切口CUTE，并联合根治性子宫切除术和双侧输卵管卵巢切除术。所有患者均置于改良膀胱截石位，无需重新定位。在脐下中线做一个小切口。首先完全经腹膜外进行双侧肾输尿管切除术，然后经腹膜进行根治性膀胱切除术并切除子宫和卵巢。
所有手术均成功完成，无重大并发症。中位手术时间为242.5分钟，估计失血量为500毫升。术后开始经口进食的中位时间为2天；中位住院时间为11天。10例患者在中位随访46.5个月时无癌；6例患者即使在复查术前计算机断层扫描后，仍被证实术前存在未检测到的UC或肾细胞癌。
这种改良技术提供了一种节省时间的全尿路切除术，以消除术前未检测到的恶性肿瘤，减少异时复发，并避免与气腹和重新定位相关的围手术期并发症。在经验丰富的医生手中，可以同时实现良好的癌症控制和早期康复。
