Objective: To investigate the efficacy and safety of complete transabdominal laparoscopic nephroureterectomy in treating primary upper tract urothelial carcinoma (UTUC) for post kidney transplantation patients. Methods: The clinical data of patients with primary renal pelvis and ureter tumors after kidney transplantation in Beijing Chaoyang Hospital from May 2016 to December 2019 were retrospectively analyzed. Seventeen patients (including 9 patients in ipsilateral transplanted kidney group and 8 patients in contralateral transplanted kidney group) underwent traditional retroperitoneoscopic nephroureterectomy (TRNU), and 24 patients (including 14 patients in ipsilateral transplanted kidney group and 10 patients in contralateral transplanted kidney group) underwent complete transperitoneal laparoscopic nephroureterectomy (CTNU). The perioperative clinical indicators of all patients were recorded and analyzed, and the surgical indicators of two techniques were compared. Results: Forty-one patients [16 males and 25 females, with a median age of 57 (53, 70) years old] were finally included. The operation time in the contralateral transplanted kidney group [(95±44) min] from CTNU was significantly decreased compared with that in the ipsilateral group from CTNU [(159±49) min] and the contralateral [(196±20) min] or ipsilateral [(205±21) min] groups from TRNU (all P<0.01). The blood loss volume [(84±39) ml vs (106±44) ml vs (109±20) ml vs (112±21) ml, P=0.271] and postoperative hospital stay [(10.6±2.1) d vs (11.8±1.7) d vs (10.3±1.5) d vs (11.4±1.5) d, P=0.171] were not statistically different among these four groups. During the median follow-up of 24 months, 13 patients developed contralateral recurrence or metastasis, 8 patients developed intravesical recurrence, and 5 patients died of UTUC. Conclusions: Single-position complete transabdominal laparoscopic nephroureterectomy for the treatment of primary renal ureteral tumors after kidney transplantation has the advantage of a short operation time, without increasing intraoperative blood loss or perioperative complications. It is suitable for the treatment of urothelial carcinoma after kidney transplantation, especially for the contralateral side of the transplanted kidney.
目的： 探讨单一体位完全经腹途径腹腔镜肾输尿管全长切除+膀胱袖口状切除治疗肾移植术后上尿路尿路上皮癌的安全性和疗效。 方法： 回顾性分析2016年5月至2019年12月首都医科大学附属北京朝阳医院收治的肾移植术后原上尿路尿路上皮癌患者临床资料。17例患者行传统经后腹腔腹腔镜原肾输尿管全长切除+膀胱袖口状切除术（根据肿瘤位置分为移植肾同侧组9例和移植肾对侧组8例）；24例患者行单一体位完全腹腔镜下原肾输尿管全长切除+膀胱袖口状切除术（根据肿瘤位置分为移植肾同侧组14例和移植肾对侧组10例）。记录并分析所有患者围手术期的相关临床资料，对两种手术方式的手术指标进行比较。 结果： 纳入41例患者，男16例，女25例，年龄57（53，70）岁。单一体位对侧组手术时间短于单一体位同侧组及后腹腔对侧组、同侧组，差异均有统计学意义［（95±44）、（159±49）、（196±20）、（205±21）min，均P<0.01］；上述各组术中出血量［（84±39）、（106±44）、（109±20）、（112±21）ml，P=0.271］、住院时间［（10.6±2.1）、（11.8±1.7）、（10.3±1.5）、（11.4±1.5）d，P=0.171］差异均无统计学意义。术后随访24个月，13例患者出现对侧复发或转移，8例出现膀胱内复发，5例死于上尿路尿路上皮癌。 结论： 单一体位全腹腔镜治疗肾移植术后原肾输尿管肿瘤具有手术时间短的优点，同时不增加术中出血及围手术期并发症，适用于治疗移植肾术后原尿路尿路上皮癌，尤其适用于移植肾对侧的原肾及输尿管切除。.
Zhonghua yi xue za zhi. 2022 Nov 29 [Epub]
W Wang, Y Xu, L Ren, X Y Yang, W Wang, H Yin, X D Zhang, X P Hu
Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.