Puppo P, Perachino M, Ricciotti G, Bozzo W
Department of Urology, S. Corona Hospital, Pietra Ligure (SV), Italy.
J Endourol. 1994 Dec;8(6):425-8. doi: 10.1089/end.1994.8.425.
In cases of advanced urologic malignancies with impairment of renal function secondary to tumor infiltration in high-risk patients, the possibility of performing a laparoscopic instead of an open cutaneous ureterostomy should be considered. We performed laparoscopic cutaneous ureterostomy in three male patients, two with prostate cancer and one with bladder cancer, and in one female patient with uterine cancer. Five operative ports were used. The ureters were identified, dissected, severed, and passed through two 10-mm ports; and cutaneous ureterostomies were performed in the usual manner. The mean operative time was 96 minutes. Patients were discharged after 5 to 7 (mean 6) days. The two patients with prostate cancer are now in treatment with GnRH analogues with a follow-up of 3 and 7 months. The patient with bladder cancer underwent palliative radiotherapy and is well after 6 months. The patient with uterine cancer has stable disease after 3 months. Laparoscopic urinary diversion causes less discomfort and has a low complication rate and may be the first-choice diversion in patients with advanced cancer who have a life expectancy longer than 6 months.
对于高危患者因肿瘤浸润导致肾功能损害的晚期泌尿系统恶性肿瘤病例，应考虑行腹腔镜下而非开放性皮肤输尿管造口术的可能性。我们对3例男性患者（2例前列腺癌、1例膀胱癌）和1例女性子宫癌患者实施了腹腔镜下皮肤输尿管造口术。使用了5个手术切口。识别、解剖、切断输尿管，并将其通过两个10毫米的切口引出；然后按常规方式进行皮肤输尿管造口术。平均手术时间为96分钟。患者在术后5至7天（平均6天）出院。2例前列腺癌患者目前正在接受促性腺激素释放激素类似物治疗，随访时间分别为3个月和7个月。膀胱癌患者接受了姑息性放疗，6个月后情况良好。子宫癌患者3个月后病情稳定。腹腔镜下尿液改道引起的不适较少，并发症发生率低，对于预期寿命超过6个月的晚期癌症患者可能是首选的改道方式。
