Akopyan G N, Alyaev Yu G, Vinarov A Z, Rapoport L M, Gazimiev M A, Tsarichenko D G, Shpot E V, Sorokin N I, Dymov A M, Pshikhachev A M, Lekarev V Yu, Akopyan G S
Research Institute of Uronephrology and Human Reproductive Health, Department and Clinic of Urology, I.M. Sechenov First MSMU.
Urologiia. 2016 Dec(6):100-106.
To assess the results of organ-sparing endoscopic treatment of patients with tumors of the upper urinary tract (UUT).
Twenty four patients underwent percutaneous and ureteropyeloscopic interventions for tumors of the upper urinary tract and were followed up at the Urology Clinic, I.M. Sechenov First MSMU. Retrograde removal of benign tumors of the renal pelvis and ureter (tumors sized from 5 to 35 mm), percutaneous removal of papillary carcinoma of renal pelvis of a solitary kidney, percutaneous removal of papillary carcinoma of renal pelvis of only one functioning kidney and percutaneous removal of papillary carcinoma of the lower calyx of the L-shaped kidney were performed in 21, 1, 1 and 1 patients, respectively. The patients had stage T1 papillary cancer of the upper urinary tract. There were 7 (29.2%) men and 17 (70.8%) women with mean age 64+/-5 years. Electroresection/vaporization was carried out in 18 patients, and 6 patients were treated using Holmium laser.
None of the endoscopic procedures required conversion to open surgery or a more extended surgical operation. There were no recurrences or impaired UUT urinary flow in patients with benign UUT tumors at different points of follow-up. In 3 cases of malignant UUT tumors no recurrences occurred during 12-20 months follow-up.
and discussion. Nephroureterectomy with resection of the urinary bladder is the standard radical treatment of patients with tumors of the UUT. Technological advances in endoscopic and percutaneous surgery for UUT have allowed for organ-sparing procedures in patients with neoplasms of pelvicalyceal system and ureter. The absolute indications for such organ-sparing operations now include solitary kidney or only one functioning kidney and chronic renal failure. Endoscopic resection of the tumor and renal pelvic wall within healthy tissue, including by holmium laser, with tumor stage not exceeding T1 and followed by trans-fistula chemotherapy can be regarded as an effective treatment for patients with tumors of pelvicalyceal system.
评估上尿路（UUT）肿瘤患者保留器官的内镜治疗效果。
24例接受经皮和输尿管肾盂镜干预治疗上尿路肿瘤的患者在莫斯科谢马什克第一国立医科大学泌尿外科诊所接受随访。分别对21例、1例、1例和1例患者进行了肾盂和输尿管良性肿瘤（肿瘤大小为5至35毫米）的逆行切除、孤立肾肾盂乳头状癌的经皮切除、仅一个功能肾肾盂乳头状癌的经皮切除以及L形肾下盏乳头状癌的经皮切除。患者患有上尿路T1期乳头状癌。其中男性7例（29.2%），女性17例（70.8%），平均年龄64±5岁。18例患者进行了电切/汽化，6例患者使用钬激光治疗。
所有内镜手术均无需转为开放手术或更广泛的手术操作。不同随访时间点，上尿路良性肿瘤患者均未出现复发或上尿路尿流受损情况。3例上尿路恶性肿瘤患者在12至20个月的随访期间未出现复发。
结论与讨论。膀胱切除的肾输尿管切除术是上尿路肿瘤患者的标准根治性治疗方法。上尿路内镜和经皮手术的技术进步使得肾盂肾盏系统和输尿管肿瘤患者能够接受保留器官的手术。目前，此类保留器官手术的绝对指征包括孤立肾或仅一个功能肾以及慢性肾衰竭。在健康组织内对肿瘤和肾盂壁进行内镜切除，包括使用钬激光，肿瘤分期不超过T1，随后进行经瘘化疗，可被视为肾盂肾盏系统肿瘤患者的有效治疗方法。
