【摘要】 目的 评价经尿道环形电切输尿管开口联合腰部切口根治肾盂癌的临床效果。方法 男性7例，女性5例，平均年龄63岁，12例肾盂癌患者先采用尿道电切镜行患侧输尿管口膀胱壁袖套状切除，而后行经腰部肾输尿管切除术。结果 12例均手术成功, 手术时间90～120 min，平均为105 min。术中出血量50～120 ml,平均90 ml。术后无严重并发症。结论 经尿道环形电切输尿管开口联合腰部切口治疗肾盂癌具有创伤小、并发症少、术后恢复快等特点，是一种安全有效的手术方法。
【关键词】 肾盂肿瘤 肾输尿管切除术
Total nephroureterectomy combined with transurethral excision of the bladder
cuff for renal pelvic carcinoma in 12 cases
WU Bin, YUAN Jun, JIANG Yue-fang, YIN Jin-long, XU Yuan, HUANG Qing
(Department of Urology, Jiangyin People′s Hospital, Jiangyin, Jiangsu 214400, China)
Abstract: Objective To evaluate the surgical technique for the treatment of renal pelvic carcinoma. Methods Twelve patients with renal pelvic calcinoma, 7 male and 5 female, aged 50-75 (av. 63), were treated in our hospital from August 2004 to July 2006. The bladder cuff on the affected side was first excised via the urethra. The patient was then posed to lie on the healthy side to undergo the total nephroureterectomy via laparotomy. Results The operation was successful in the whole series, lasted 90 -120 min (av. 105 min), with blood loss averaged 90 ml (50-120 ml). No serious complications were encountered after the operation. Conclusions The modified surgical technique is effective for the treatment of renal pelvic carcinoma, causing less trauma and fewer complications and allowing quick recovery.
Key words: renal pelvic neoplasms; nephroureterectomy
我院自2004年8月至2006年7月期间对12例肾盂癌患者采用先经尿道环形电切输尿管开口，再经腰部切口作肾输尿管全长切除术，效果满意。现报告如下。
1 资料和方法
1.1 临床资料 本组12例。男7例，女5例，年龄50~75岁，平均63岁，左侧7例，右侧5例。本组12例术前均行B超、CT、静脉尿路造影(KUB+IVP)、逆行肾盂造影检查、尿脱落细胞学检查，诊断为肾盂癌。
1.2 手术方法 手术采用硬脊膜外麻醉或全身麻醉，麻醉成功后患者先取膀胱截石位,首先用电切镜经尿道用钩形电极沿患侧输尿管口周围环形电切开膀胱壁直至显露膀胱周围脂肪，创缘电凝止血，留置三腔导尿管。若患者输尿管开口较小电切过程中可能出现界限不清，则先膀胱镜下行患侧输尿管逆行插管并予以留置，再更换电切镜后以输尿管导管为引导,用钩形电极环切输尿管开口。再将患者改为健侧卧位，行肾输尿管切除术：取患侧腰部11肋间或经12肋切口，逐层切开至腹膜后，游离肾脏背侧，紧贴腰大肌表面与肾周筋膜间游离至肾门部，扪及肾动脉搏动，游离出肾动脉后结扎、切断，在肾动脉的内前方找到肾静脉，同法结扎、切断。继续在肾周筋膜外游离整个肾脏提
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