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经尿道输尿管膀胱壁内段肿瘤电切术的临床疗效分析

Clinical efficacy analysis of transurethral resection of intramural ureteral tumors

  • 摘要:
    目的 探讨经尿道输尿管膀胱壁内段肿瘤电切术的疗效与安全性。
    方法 回顾性分析2020年5月至2023年5月在海军军医大学第一附属医院诊治的接受经尿道输尿管膀胱壁内段肿瘤电切术的26例输尿管癌(尿路上皮癌)患者的临床资料。所有患者采用“外楔内旋”的电切治疗方式,术中放置输尿管支架。分析手术时间、术中出血量、术后住院时间、输尿管支架留置时间、术中及术后并发症、术后病理结果、膀胱肿瘤复发率等临床指标。
    结果 所有手术均顺利完成,手术时间45(35, 60) min,术中出血量5(3, 10) mL,术后住院时间4(3, 5) d,输尿管支架留置时间(33.8±9.7)d。所有患者均未发生术中并发症,术后肾积水发生率为3.8%。术后病理检查示pTa期6例、pT1期16例、pT2a期4例。随访12~48个月,2例患者发生膀胱内肿瘤复发,复发率为7.7%,无肿瘤相关死亡。
    结论 经尿道输尿管膀胱壁内段肿瘤电切术具有创伤小、出血量少的优势,同时能较好地保留肾功能,术后肾积水和输尿管积水等并发症发生率低。

     

    Abstract:
    Objective To explore the efficacy and safety of treatment of intramural ureteral tumors via transurethral resection.
    Methods A retrospective analysis was conducted on the clinical data of 26 patients with ureteral cancer who underwent transurethral resection of intramural ureteral tumors at the First Affiliated Hospital of Naval Medical University from May 2020 to May 2023. All patients were treated using the “outer-wedge, inner-rotation” resection technique, with ureteral stents placed intraoperatively. Clinical indicators including operation time, intraoperative blood loss, length of postoperative hospital stay, ureteral stent indwelling duration, intraoperative and postoperative complications, postoperative pathological results, and bladder tumor recurrence rate were analyzed.
    Results All surgeries were successfully completed. The operation time was 45(35, 60) min, intraoperative blood loss was 5(3, 10) mL, length of postoperative hospital stay was 4(3, 5) d, and the ureteral stent indwelling duration was (33.8±9.7) d. All patients did not experience intraoperative complications, the postoperative hydronephrosis rate was 3.8%. Postoperative pathology confirmed urothelial carcinoma in all cases, including 6 cases of stage pTa, 16 cases of pT1, and 4 cases of pT2a. The follow-up period ranged from 12 to 48 months. Intravesical recurrence occurred in 2 patients, and recurrence rate was 7.7%. There were no tumor-related deaths during the follow-up period.
    Conclusions Transurethral resection of intramural ureteral tumors is minimally invasive, resulting in less blood loss, and has low rates of postoperative complications such as hydronephrosis and hydroureter. It achieves favorable surgical outcomes while better preserving renal function.

     

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