CAJ | 학술논문

目的探讨腹腔镜治疗肾移植术后尿路上皮癌的效果.方法 1130例肾移植受者中9例(0.8％,9/1130)发生自体上尿路上皮癌,其中右侧输尿管肿瘤2例,右侧肾盂肿瘤2例,左侧肾盂肿瘤2例,左侧输尿管上段肿瘤1例,双侧上尿路同时或先后发生肿瘤2例(1例为双侧输尿管肿瘤,1例为右侧输尿管肿瘤合并左侧肾盂肿瘤).9例中,男性1例,女性8例.左侧肾盂和输尿管肿瘤采用经腹膜后途径腹腔镜肾脏和输尿管全切联合经尿道电切的方法治疗.右侧上尿路肿瘤采用70°斜卧位经腹腔途径肾脏和输尿管切除并膀胱袖状切除.术后通过膀胱灌注化疗.将钙调磷酸酶类免疫抑制剂转换为西罗莫司.结果 9例手术(包括2例双侧手术)均获得成功,术后病理检查结果均证实为尿路上皮癌.随访6个月至4年,未发现切口肿瘤种植转移.1例术后8个月死于尿路上皮癌肺转移,1例术后7个月发生乳腺癌,其他7例目前无瘤存活,肾功能均正常.结论腹腔镜手术治疗肾移植术后自体尿路上皮癌效果较好,具有创伤小、恢复快等优点.左侧和右侧肿瘤应采用不同的手术方法.
목적 탐토복강경치료신이식술후뇨로상피암적효과.방법 1130례신이식수자중9례(0.8％,9/1130)발생자체상뇨로상피암,기중우측수뇨관종류2례,우측신우종류2례,좌측신우종류2례,좌측수뇨관상단종류1례,쌍측상뇨로동시혹선후발생종류2례(1례위쌍측수뇨관종류,1례위우측수뇨관종류합병좌측신우종류).9례중,남성1례,녀성8례.좌측신우화수뇨관종류채용경복막후도경복강경신장화수뇨관전절연합경뇨도전절적방법치료.우측상뇨로종류채용70°사와위경복강도경신장화수뇨관절제병방광수상절제.술후통과방광관주화료.장개조린산매류면역억제제전환위서라막사.결과 9례수술(포괄2례쌍측수술)균획득성공,술후병리검사결과균증실위뇨로상피암.수방6개월지4년,미발현절구종류충식전이.1례술후8개월사우뇨로상피암폐전이,1례술후7개월발생유선암,기타7례목전무류존활,신공능균정상.결론 복강경수술치료신이식술후자체뇨로상피암효과교호,구유창상소、회복쾌등우점.좌측화우측종류응채용불동적수술방법.
Objective To investigate the clinical outcome of laparoscopic nephroureterectomy (LUNT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients.Methods We conducted a retrospective analysis on 1130 RT recipients,and 9 patients (0.8％,9/1130) with native upper tract UC were identified. UC was confirmed pathologically in the 9 patients,including 3 cases of unilateral ureter tumor (2 on the right,and 1 on the left),4 cases of unilateral renal pelvis tumor (2 on the right,2 on the left),1 case of bilateral ureter tumor and 1 case of tumor in the right ureter and left kidney.Females predominated (8/9) in the 9 patients with upper tract UC.The patients with left upper urinary tract cancer underwent LUNT using a retroperitoneal approach with a technique of transurethral circumcision of the ureteral orifice.The patients with right upper urinary tract cancer were subjected to nephroureterctomy with ureterectomy and bladder cuff excision by complete laparascopy through a transperitoneal approach. Immunosuppressive protocol conversion from calcineurin inhibitors to sirolimus was performed on all cases. Results In the 9 patients,11 LUNTs were performed successfully without conversion to open surgery.The follow-up period was from 6 to 48 months. One patient died of lung metastasis at 8th month after tumor excision,and 1 patient displayed ductal cancer of the left breast at 7th month after LNUT.Another seven patients showed no evidence of disease during the follow-up period with normal renal function.Conclusion Our present clinical experience suggested that LNUT for the native upper tract cancer in renal transplant recipients is feasible,safe,and effective.