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首页> 外文期刊>BJU international >Purse-string technique for laparoscopic excision of a bladder mucosal cuff in patients with transitional cell carcinoma of the upper urinary tract: initial report with intermediate follow-up.
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Purse-string technique for laparoscopic excision of a bladder mucosal cuff in patients with transitional cell carcinoma of the upper urinary tract: initial report with intermediate follow-up.

机译：上弦移行上皮细胞癌患者的腹腔镜切除膀胱粘膜袖带的荷包技术：初次报告，中期随访。

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摘要

OBJECTIVE: To describe a novel modification for excision of a bladder mucosal cuff around the ipsilateral ureter during laparoscopic nephroureterectomy (LNU) in the patients with upper urinary tract transitional cell carcinoma (TCC). PATIENTS AND METHODS: Between 2003 and 2007, 13 patients with upper urinary TCC were managed by LNU with excision of a bladder mucosal cuff. The renal pedicle was clipped early. The kidney was freed. The ureter was dissected down to the vesico-ureteric junction. The intramural part of the ureter was dissected under vision and sharply freed from the surrounding detrusor muscle of the bladder until the level of the ureteric orifice. Then the detrusor muscle was further dissected away from the underneath bladder mucosa for 1 cm around the ureteric orifice. Thus, a bladder cuff of mucosa-only could be retrieved. A purse-string suture was taken at the edge of the dissected mucosa and the cuff was excised. The intaoperative and postoperative outcome and morbidity were recorded and results of the short- and intermediate-term follow-up were evaluated. RESULTS: All the procedures were completed by laparoscopy. The mean operative time was 226 min. The mean blood loss was 233 mL. There were no major complications. The median follow-up was 31.5 months. During follow-up, one patient developed recurrence in the renal bed. There was no pelvic recurrences. Two patients developed papillary bladder tumours. CONCLUSION: The purse-string technique enabled complete LNU without opening of the pelvicalyceal system. Short- and intermediate-term follow-up showed the oncological safety of the procedure. The outcomes from more patients with a longer follow-up are required to confirm these preliminary findings.
机译：目的：描述上尿路移行细胞癌（TCC）患者腹腔镜肾结直肠癌切除术（LNU）切除同侧输尿管周围膀胱粘膜袖带的新方法。患者与方法：2003年至2007年，通过LNU切除膀胱粘膜袖带，对13例上尿TCC患者进行了治疗。早期切除肾蒂。肾脏被释放。将输尿管解剖至膀胱-输尿管交界处。在视觉下解剖输尿管的壁内部分，并使其与膀胱周围的逼尿肌完全脱离，直到输尿管口水平。然后将逼尿肌从输尿管口周围的膀胱粘膜下进一步切开1 cm。因此，可以收回仅粘膜的膀胱套囊。在切开的粘膜的边缘处进行荷包缝合，并切下袖带。记录术中和术后的结局和发病率，并评估短期和中期随访的结果。结果：所有手术均通过腹腔镜完成。平均手术时间为226分钟。平均失血量为233 mL。没有重大并发症。中位随访时间为31.5个月。在随访期间，一名患者肾床复发。没有骨盆复发。两名患者出现了乳头状膀胱肿瘤。结论：囊弦技术使完整的LNU得以开放，而无需打开骨盆腔系统。短期和中期随访显示了该程序的肿瘤学安全性。需要更多随访时间更长的患者来确认这些初步发现。

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