Geavlete P, Jora T
Clinica de Urologie, Spitalul Clinic Sf. Ioan, Bucureşti.
Chirurgia (Bucur). 1998 Mar-Apr;93(2):107-14.
Nephroureterectomy with ureteral stump excision and perimeatal cystectomy is the "golden standard surgical approach" for urothelial upper urinary tract cancer. Nephroureterectomy is also necessary in renoureteral tuberculosis, with compromised renal unit. Since June 1995 we performed the endoscopic distal ureteral approach in 11 cases (9 cases with upper urinary tract cancer and 2 cases with renal tuberculosis and concomitant ureteral distal lesions). In 7 cases we performed ureteral stripping after nephrectomy and in 4 cases we performed endoscopic disconnection of the intramural ureter followed by nephroureterectomy (in one operative step). Ureteral stripping was realized in two ways: perimeatal resection of the ureter and 12 o'clock incision. There was only one intraoperative complication which consisted in the dislodgement of the ureteral catheter who needs conversion to open surgery. Mean follow-up period was 12 months (range 2 to 28). The evolution of the patients was satisfactory, with significant reduction of the hospitalization. According to our experience the endoscopic distal ureteral approach is a safer complementary proceeding to the one step nephroureterectomy, being performed faster and easier than open ureterectomy.
肾输尿管切除术联合输尿管残端切除术及尿道口囊肿切除术是尿路上皮性上尿路癌的“金标准手术方法”。对于肾输尿管结核且肾功能受损的患者，肾输尿管切除术也是必要的。自1995年6月以来，我们对11例患者采用了内镜下输尿管远端入路（9例为上尿路癌，2例为肾结核合并输尿管远端病变）。其中7例在肾切除术后进行输尿管剥脱术，4例在内镜下离断壁内段输尿管后行肾输尿管切除术（一步完成）。输尿管剥脱术通过两种方式实现：输尿管尿道口切除术和12点切口。术中仅出现1例并发症，即输尿管导管移位，需转为开放手术。平均随访期为12个月（范围2至28个月）。患者病情进展令人满意，住院时间显著缩短。根据我们的经验，内镜下输尿管远端入路是一期肾输尿管切除术更安全的补充手术，比开放输尿管切除术操作更快、更简便。
