现代泌尿生殖肿瘤杂志
現代泌尿生殖腫瘤雜誌
현대비뇨생식종류잡지
JOURNAL OF CONTEMPORARY UROLOGIC AND REPRODUCTIVE ONCOLOGY
2015年
2期
72-75
,共4页
尿毒症%肾盂癌%综合治疗%肾输尿管全长切除%膀胱袖套状切除
尿毒癥%腎盂癌%綜閤治療%腎輸尿管全長切除%膀胱袖套狀切除
뇨독증%신우암%종합치료%신수뇨관전장절제%방광수투상절제
Uremia%Renal pelvic cancer%Comprehensive treatment%Pelvis-uterine%Bladder cuff resection
目的：总结我中心尿毒症透析并发肾盂癌患者手术治疗及围手术期处理的临床资料和经验。方法我中心1997年2月至2012年9月收治尿毒症并发肾盂癌的患者7例,年龄39~69(54.0±10.4)岁,男女比5∶2,患者每周行血液透析2~3次,维持时间21~58(42.7±12.4)个月,患者24 h 尿量为0~200 ml。手术前3~5 d 患者接受每天透析,纠正贫血、凝血功能障碍及低蛋白血症。7例患者接受开放性患侧肾输尿管全长及膀胱袖套状切除术,所有手术顺利完成。患者术后接受吡柔比星预防性膀胱灌注化疗1年。结果7例患者手术时间为184~300(230.3±39.2)min,术中出血量200~400(302.9±77.6)ml,术中、术后患者循环稳定,术后根据患者中心静脉压制定补液方案,术后第3天开始进行无肝素化血液透析治疗。术后4~9(6.3±1.6)d 拔除引流管,所有患者恢复顺利,术后住院9~17(13.1±3.0)d。7例患者接受规律复查、随访,随访时间为22~84(51.4±19.6)个月,1例因心肌梗塞死亡,1例膀胱内肿瘤复发行再次 TURBT,其余5例无复发生存。结论尿毒症并发肾盂癌患者经过手术前积极准备,接受患侧肾输尿管全长及膀胱袖套状切除手术,术后注意控制出入量、及时恢复透析,并进行膀胱预防性灌注化疗,患者治疗效果良好。
目的：總結我中心尿毒癥透析併髮腎盂癌患者手術治療及圍手術期處理的臨床資料和經驗。方法我中心1997年2月至2012年9月收治尿毒癥併髮腎盂癌的患者7例,年齡39~69(54.0±10.4)歲,男女比5∶2,患者每週行血液透析2~3次,維持時間21~58(42.7±12.4)箇月,患者24 h 尿量為0~200 ml。手術前3~5 d 患者接受每天透析,糾正貧血、凝血功能障礙及低蛋白血癥。7例患者接受開放性患側腎輸尿管全長及膀胱袖套狀切除術,所有手術順利完成。患者術後接受吡柔比星預防性膀胱灌註化療1年。結果7例患者手術時間為184~300(230.3±39.2)min,術中齣血量200~400(302.9±77.6)ml,術中、術後患者循環穩定,術後根據患者中心靜脈壓製定補液方案,術後第3天開始進行無肝素化血液透析治療。術後4~9(6.3±1.6)d 拔除引流管,所有患者恢複順利,術後住院9~17(13.1±3.0)d。7例患者接受規律複查、隨訪,隨訪時間為22~84(51.4±19.6)箇月,1例因心肌梗塞死亡,1例膀胱內腫瘤複髮行再次 TURBT,其餘5例無複髮生存。結論尿毒癥併髮腎盂癌患者經過手術前積極準備,接受患側腎輸尿管全長及膀胱袖套狀切除手術,術後註意控製齣入量、及時恢複透析,併進行膀胱預防性灌註化療,患者治療效果良好。
목적：총결아중심뇨독증투석병발신우암환자수술치료급위수술기처리적림상자료화경험。방법아중심1997년2월지2012년9월수치뇨독증병발신우암적환자7례,년령39~69(54.0±10.4)세,남녀비5∶2,환자매주행혈액투석2~3차,유지시간21~58(42.7±12.4)개월,환자24 h 뇨량위0~200 ml。수술전3~5 d 환자접수매천투석,규정빈혈、응혈공능장애급저단백혈증。7례환자접수개방성환측신수뇨관전장급방광수투상절제술,소유수술순리완성。환자술후접수필유비성예방성방광관주화료1년。결과7례환자수술시간위184~300(230.3±39.2)min,술중출혈량200~400(302.9±77.6)ml,술중、술후환자순배은정,술후근거환자중심정맥압제정보액방안,술후제3천개시진행무간소화혈액투석치료。술후4~9(6.3±1.6)d 발제인류관,소유환자회복순리,술후주원9~17(13.1±3.0)d。7례환자접수규률복사、수방,수방시간위22~84(51.4±19.6)개월,1례인심기경새사망,1례방광내종류복발행재차 TURBT,기여5례무복발생존。결론뇨독증병발신우암환자경과수술전적겁준비,접수환측신수뇨관전장급방광수투상절제수술,술후주의공제출입량、급시회복투석,병진행방광예방성관주화료,환자치료효과량호。
Objective To illustrate the experience of periopeative comprehensive treatment and surgery of uremia patients with renal pelvic cancer in our hospital. Methods Seven patients suffer-ing from uremia proved to be renal pelvic cancer received open surgery of Open nephro-ureterectomy with bladder cuff resection in our center between Feb 1997 to Sep 2012.The average age of these patients were 39-69 (54.0 ± 10.4)years old.Male/Female=5 ∶2.All patients underwent hemodialysis 2 to 3 times per week for 21-58 (42.7±12.4)months.The urine volume of 24 hours is 0 to 200 ml.Before the surgery,all patients underwent hemodialysis every day for 3 to 5 days,and the situation of anemia,hy-poalbuminemia and coagulative abnormal were corrected,all patients resumed regular hemodialysis at the 3rd day after the surgery,then received routine preventive chemotherapy of bladder perfusion and follow-up for 1 year. Results All surgeries were successful,and the operative time was 184-300 (230.3± 39.2)min,and the estimated blood loss was 200-400 (302.9 ± 77.6)ml.The amount of postoperative intravenous infusion was strictly limited according to central venous pressure.No hep-arin hemodialysis were performed at the 3rd day after surgery.The drainage tubes were removed at the 4-9 (6.3±1.6)day after operation.Postoperative hospital stay was 9-1 7 (13.1 ±3.0)days.In the 1 year follow-up duration,1 patient died of incident cardiac infarction,1 patient had non-muscle invasive bladder cancer and received TURBT. Conclusions With comprehensive peri-opeative treatment,open surgery to uremia patients with pelvic cancer could be safe and effective.
