全腹腔鏡腎臟輸尿管及膀胱袖口切除術:中國醫藥大學附設醫院之經驗分享
陳冠亨、蕭博任、張議徽、張兆祥
中國醫藥大學附設醫院 泌尿部
Pure Laparoscopic Nephroureterectomy and Bladder Cuff Excision : CMUH Experience
Guang-Heng Chen, Po-Jen Hsiao , Yi-Huei Chang , Chao-Hsiang Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose: To describe pure laparoscopic nephroureterectomy and bladder cuff excision in the patients with upper urinary tract urothelial carcinoma (UC).
Materials and Methods: Between January 2014 to March 2016 , 26 patients with upper urinary UC were managed by pure laparoscopic nephroureterectomy and bladder cuff excision. The renal pedicle was clipped early. The kidney was freed. The ureter was dissected down to the vesico-ureteral junction. The intramural part of the ureter was dissected under vision and sharply freed from the surrounding detrusor muscle of the bladder until the level of the ureteric orifice. Then the detrusor muscle was further dissected away from the underneath bladder mucosa. Thus, a bladder cuff of mucosa-only could be excised. A continuous laparoscopic suture was taken at the edge of the dissected mucosa and the cuff which was excised. The intaoperative and postoperative outcomes were recorded and results of the short-term follow-up were evaluated.
Results: All the procedures were completed by laparoscopy. The mean operative time was 252 min. The mean blood loss was 152 mL. There were no major complications. The median follow-up was 6.3 months. During follow-up, no patient developed recurrence in the renal bed . There was also no pelvic recurrences. Four patients (15.4%) developed papillary bladder tumors.
Conclusions: The pure laparoscopic technique enabled complete LNU without opening of the pelvicalyceal system. Short-term follow-up showed the oncological safety of the procedure. The outcomes from more patients with a longer follow-up are required to confirm these preliminary findings.