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 for upper tract urothelial cancer : Technical considerations, perioperative and intermediate oncologic outcomes
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 patients with upper urinary tract urothelial carcinoma (UC).
Materials and Methods: From August 2013 to August 2016, 50 patients with upper urinary UC were received pure laparoscopic nephroureterectomy and bladder cuff excision. Renal pedicles was were clipped early and the kidneys was were freed. Different to conventional open method for bladder cuff excision , the ureter was dissected down to the vesico-ureteral junction under laparoscopy , and 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. The detrusor muscle was then further dissected away from the bladder mucosa. , thereby allowing for excision of a bladder cuff consisting of only mucosa. A continuous laparoscopic suture was made at the edge of the dissected mucosa and the cuff. The intraoperative and postoperative outcomes were recorded and short-term follow-up results were evaluated.
Results: All procedures were completed by laparoscopy. The mean operative time was 277.13±75.37 (minutes, and the mean blood loss was 152.17 ml. No major complications were noted, and none of the patients developed recurrence in the renal bed or pelvis over a mean follow-up period was of 19.5 months. Five patients (10%) developed papillary bladder tumors. We had always achieve adequate excised adequately of the intramural ureter and ureteral orifice, which as was confirmed by the follow-up cystoscope.
Conclusions: The pure laparoscopic technique enabled laparoscopic nephroureterectomyLNU with adequate excision of the bladder cuff. Short-term follow-up showed the oncological safety of the procedure. Further large-scale studies with a longer follow-up are required to confirm these preliminary findings.