摘要
目的评价先经尿道切除膀胱壁段输尿管的肾输尿管切除治疗上尿路移行细胞癌的临床效果。方法回顾性非随机对58例局限性上尿路移行细胞癌的患者进行比较研究,25例用电切镜先经尿道切除膀胱壁段输尿管后再行腰部切口行肾输尿管切除,33例采用常规的腰部或第11肋间切口肾输尿管切除后再做下腹部切口行膀胱袖状切除。比较两组手术时间、出血量和膀胱肿瘤的复发率。结果经尿道切除膀胱壁段输尿管的手术时间明显短于标准的两个切口的手术时间(平均112与186min,P<0.05),出血量明显低(平均108与251ml,P<0.01)。随访6～51个月时,先经尿道切除膀胱壁段输尿管膀胱内肿瘤复发4例(16%),两个切口手术组膀胱内肿瘤复发6例(18%)。结论先经尿道切除膀胱壁段输尿管的肾输尿管切除治疗上尿路移行细胞癌创伤小、手术时间短、出血量少,并不增加膀胱肿瘤的复发率,是局限性上尿路肿瘤的有效手术方法之一。
Objective To evaluate the clinical outcome of pre - transurethral resection of the intramural ureter before nephroureterectomy for upper urinary tract tumors. Methods 58 patients with localized upper urinary tract transitional cell carcinoma were enrolled in a retrospective comparative non -randomized study. Of them,25 patients with resectoscope for transurethral resection of the intramural ureter were performed as an initial step for subsequent nephroureterectomy via single lumbar incision and 33 underwent conventional nephroureterectomy with a bladder cuff. The operation time, intraoperative blood loss vdume and incidence of bladder tumors in postoperative were compared. Results The operating time for patients with transurethral resection of the intramural ureter was significantly shorter than that for those with a standard two -incision nepbroureterectomy（ median 112 and 186 minutes, P 〈 0.05 ） ; the amount of blood loss was significantly less（ median 108 and 251 ml, P 〈0.01 ）. When the patients were followed up for 6 to 51 months, intravesical recurrence was detected in 4（ 16% ） of the 25 patients with transurethral resection of the intramural ureter, 6（ 18% ）of 33 patients treated by the standard two - incision nephroureterectomy experienced intravesical recurrence. Conclusion Pre - transurethral resection of the intramural ureter before nephroureterectomy for upper urinary tract transitional cell carcinoma is a minimally invasiae procedure with shorter operating time and less blood loss, without increasing intravesical tumors recurrence rate. The modified surgical technique is effective for the treatment of localized for upper urinary tract tumors.
出处
《医学研究杂志》
2008年第12期64-67,共4页
Journal of Medical Research
基金
河北省科技厅"研究与发展指导计划"课题(05276176)
关键词
肾盂
输尿管
癌
经尿道手术
Kidney pelvis
Ureter
Carcinoma
Transurethral surgical
