Xie Zhifei, Liu Mingwen, Chen Shulian, Tang Wen, Liang Guobiao, Xu Jingyu, Zhao Zeju
Department of Urology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, Guizhou, China.
Front Oncol. 2024 Aug 9;14:1426003. doi: 10.3389/fonc.2024.1426003. eCollection 2024.
Radical nephroureterectomy (RNU) with bladder sleeve resection is currently the gold standard for the treatment of high-risk ureteral cancer. However, in certain special cases, such as bilateral upper tract urothelial carcinoma(UTUC), isolated and chronic kidney disease, and low-risk UTUC, kidney sparing surgery(KSS) may represent a viable alternative, though it remains highly challenging. The current KSS options for ureteral cancer include endoscopic treatment, segmental ureterectomy, total ureterectomy combined with kidney autotransplantation and nephrostomy. These methods are associated with significant disadvantages, such as a high risk of recurrence and vascular-related complications. On the basis of previous studies, we creatively proposed a surgical method of long segment ureterectomy with tapered demucosalized ileum(TDI) replacement of the ureter for ureteral cancer, and successfully performed this operation on a patient with ureteral cancer. The follow-up results showed that this surgical method provides good tumor control while preserving the patient's renal function and improves the inherent defect of the ileal replacement of the ureter, which is a feasible choice for patients with ureteral cancer and kidney preservation.
根治性肾输尿管切除术（RNU）联合膀胱袖状切除术目前是治疗高危输尿管癌的金标准。然而，在某些特殊情况下，如双侧上尿路尿路上皮癌（UTUC）、孤立性慢性肾病和低危UTUC，保留肾手术（KSS）可能是一种可行的替代方案，尽管它仍然具有很大的挑战性。目前用于输尿管癌的KSS选择包括内镜治疗、节段性输尿管切除术、全输尿管切除术联合肾脏自体移植和肾造瘘术。这些方法存在显著缺点，如复发风险高和血管相关并发症。基于以往的研究，我们创新性地提出了一种采用带锥形去黏膜回肠（TDI）替代输尿管的长段输尿管切除术治疗输尿管癌的手术方法，并成功地为一名输尿管癌患者实施了该手术。随访结果表明，这种手术方法在保留患者肾功能的同时能实现良好的肿瘤控制，并改善了回肠替代输尿管的固有缺陷，对于有保留肾脏需求的输尿管癌患者来说是一种可行的选择。
