输尿管开口完整切除技术在膀胱癌治疗中的应用

Application of en bloc resection of ureteral orifice in the treatment of tumors around ureteral orifice

摘要

目的 探讨输尿管开口完整切除技术在治疗输尿管口周围膀胱肿瘤中的临床效果。方法 回顾性分析2018年7月-2023年6月南京大学医学院附属鼓楼医院泌尿外科收治的43例输尿管口周围膀胱肿瘤患者的临床资料，其中男性34例，女性9例。所有患者术前均通过影像学或膀胱镜检查确诊为膀胱占位性病变，且未合并上尿路肿瘤。所有患者均接受经尿道膀胱肿瘤电切术，切除输尿管开口周围肿瘤后完整切除输尿管开口，电凝止血后电切镜下于患侧输尿管置入双J管。术后观察肿瘤复发及肾积水情况。结果 所有手术均顺利完成，未中转为开放手术，手术时间（61±25）min。术后病理结果：Ta期28例，T1期14例，T2期1例。术后随访（17±11）个月，8例（19%）患者肿瘤复发，其中4例（9%）复发累及输尿管口周围。术后拔除双J管后有1例（2%）出现一过性肾积水。结论 输尿管开口完整切除技术联合双J管置入术在输尿管口周围肿膀胱瘤治疗中安全有效，术后复发率较低，是早期患者的可选术式。

Abstract

Objective To investigate the clinical efficacy of en bloc resection of ureteral orifice in the treatment of tumors around ureteral orifice. Methods Clinical data of 43 patients treated at our hospital during Jul. 2018 and Jun. 2023 were retrospectively analyzed, including 34 male and 9 female patients. Prior to surgical intervention, all patients were diagnosed with bladder masses via imaging or cystoscopy, and no concurrent upper urinary tract tumors were detected. The initial surgical procedure was transurethral resection of bladder tumor, which removed the tumors around ureteral orifice. Subsequently, electrocoagulation was employed for hemostasis, followed by the placement of a double-J tube into the affected ureter. Tumor recurrence and hydronephrosis were observed after operation. Results All operations were successful without conversion to open surgery. The operation time was (61±25) min. The postoperative pathological results showed 28 cases of Ta stage tumors, 14 cases of T1 stage tumors, and 1 case of T2 stage tumor. During the follow-up of (17±11) months, 8 patients (19%) had tumor recurrence, among whom 4 (9%) had recurrent tumor involving the ureteral orifice, and 1 (2%) had transient hydronephrosis after removal of double-J tube. Conclusion The en bloc resection of the ureteral orifice with placement of a double-J tube is safe and effective for the treatment of tumors around the ureteral orifice, with low recurrence rate. It is an optional procedure for early stage patients.

关键词

输尿管口 / 膀胱肿瘤 / 整块切除 / D-J管 / 经尿道膀胱肿瘤电切术

Key words

ureteral orifice / bladder tumor / en bloc resection / double-J tube / transurethral resection of bladder tumor

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