改良型Pluck技術:經尿道輸尿管閉塞及膀胱縫合應用在腎臟輸尿管切除併膀胱袖口切除對於上泌尿道尿路上皮癌的治療
陳建廷、王百孚、江恆杰、黃勝賢、張進寶
彰化基督教醫院 外科部 泌尿科
Refined pluck technique by ureteral occlusion and transurethral cystorrhaphy in nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma
Jian Ting Chen, Bai-Fu Wang , Herng-Jye Jiang, Sheng-Hsien Huang ,Chin-pao Chang
Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua
Purpose:
To evaluated the feasibility of refined pluck technique by ureteral occlusion and transurethral cystorrhaphy in nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma (UTUC)
Materials and Methods:
Between July 2014 and March 2015, 6 female patients received refined pluck technique by ureteral occlusion and transurethral cystorrhaphy in nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma (UTUC). At beginning, the ureter orifice was occluded with intravesical silk suture transurethrally aided by extracorporeal knot tying. Transurethral excision of bladder cuff was performed by circumcision of the ureteric orifice and intramural ureter with a Collins knife. The bladder cuff is freed deeply to extravesical space allowing subsequent“plucking” of the entire ureter from above. The bladder defect is repaired with absorbable sutures transurethrally. The tumor was pyelocaliceal in 4 cases, ureteral in 2 cases. The follow-up was performed by cystoscopy, urine cytology and computed tomography (CT) scan. We present our preliminary data.
Results:
4 transperitoneal robot‑assisted laparoscopic nephroureterectomy with bladder cuff excision and 2 hand-assisted retroperitoneoscopic nephroureterectomy with bladder cuff excision were performed .All patients are female. Histology showed high grade in everyone. There were 2 patients with pT1 staging, 2 patients with pT2 staging and 2 patients with pT3 staging. There was no lymph node metastasis found in the specimen and all surgical margin were clear. No major perioperative complications occurred.
Conclusion:
This refined pluck technique by ureteral occlusion and transurethral cystorrhaphy in nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma (UTUC) is a safe and effective alternative according to our preliminary experience. Long term follow-up and larger patient number are needed.