Guo Gang, Yang Yong, Dong Jun, Zhenhong Zhou, Zhang Xu
1 Department of Urology, PLA General Hospital , Beijing, China .
J Endourol. 2015 Apr;29(4):430-4. doi: 10.1089/end.2014.0024. Epub 2015 Mar 16.
Retroperitoneal laparoscopic nephroureterectomy (LNU) is a classic technique for the treatment of patients with urothelial cancer of the upper urinary tract. Management of the distal ureter in patients undergoing this procedure remains controversial, however. We evaluated a new method involving cystoscopic sleeve resection of the distal ureter using a 2-μm continuous wave laser before LNU.
LNU was performed in 38 patients at our hospital between January 2008 and January 2012. The distal end of the ureter was managed by using a 2-μm continuous wave laser to evaporate and excise the ureteral orifice and bladder cuff. A standard technique was applied to keep the ureter intact. The ureter was dissected to the entrance of the bladder, and the distal ureter was easily detached from the bladder.
The distal ureter was excised completely in all cases using this new technique. The average operative time was 2.4 hours, and the average blood loss was 69.4 mL. At 1 year after surgery, the cause-specific survival rate of the patients was 100%, the bladder recurrence-free rate was 89%, and the extravesical recurrence-free rate was 100%.
For managing the distal ureter during LNU, the new technique described proved to be a simple, safe, and minimally invasive method.
腹膜后腹腔镜肾输尿管切除术（LNU）是治疗上尿路尿路上皮癌患者的经典技术。然而，该手术患者远端输尿管的处理仍存在争议。我们评估了一种新方法，即在LNU前使用2微米连续波激光经膀胱镜袖状切除远端输尿管。
2008年1月至2012年1月期间，我院对38例患者实施了LNU。通过使用2微米连续波激光汽化并切除输尿管口和膀胱袖口来处理输尿管远端。采用标准技术保持输尿管完整。将输尿管解剖至膀胱入口处，远端输尿管很容易从膀胱分离。
使用这种新技术，所有病例的远端输尿管均被完全切除。平均手术时间为2.4小时，平均失血量为69.4毫升。术后1年，患者的病因特异性生存率为100%，膀胱无复发生存率为89%，膀胱外无复发生存率为100%。
对于LNU术中远端输尿管的处理，所描述的新技术被证明是一种简单、安全且微创的方法。
