- 期刊
Pure Laparoscopic Nephroureterectomy with a Concomitant Radical Cystoprostatectomy for Multifocal Urothelial Carcinoma in Male Uremic Patients: 2 Case Reports and Literature Review
使用純腹腔鏡腎輸尿管切除術及根除性膀胱攝護腺切除術治療男性尿毒症病患之多發性泌尿上皮癌：病例報告及文獻回顧
摘要
在台灣，泌尿上皮癌是接受定期透析治療的尿毒症患者最常見的泌尿道惡性腫瘤。對於上下泌尿道同時存在多發性的腫瘤，傳統的手術治療需要一條極長的手術傷口（從胸骨劍突至恥骨聯合）。在這微創手術的時代，腹腔鏡泌尿道手術已逐漸取代傳統手術方式。在此報告兩位男性病患我們以純腹腔鏡手術同時切除腎輸尿管及膀胱攝護腺的初步經驗。這兩位病患都曾因罹患上泌尿道及膀胱泌尿上皮癌而接受腹腔鏡單側腎輸尿管切除術及經尿道膀胱腫瘤切除術。追蹤時發現在對側上泌尿道及膀胱有腫瘤復發跡象。我們以純腹腔鏡手術一次同時執行腎輸尿管切除術及根除性膀胱攝護腺切除術，取下的標本從舊有之下腹部傷口取出。兩病患分別於術後第四天及第七天順利出院，在追蹤的八個月內無併發症產生，且無腫瘤復發之跡象。依據我們的初步經驗，對於罹患多發性上皮癌的男性尿毒症患者，使用純腹腔鏡同時進行腎輸尿管切除術及根除性膀胱攝護腺切除術為一安全，有效且較低侵襲性的替代方案。
並列摘要
Urothelial carcinoma I carcinoma (TCC) is the most-common urotract cancer in patients receiving maintenance dialysis in Taiwan. Traditionally, a long midline incision extending from the xyphoid to the pubic symphysis was required to treat synchronous multifocal lesions in both the upper and lower urinary tract. In the era of minimally invasive surgery, laparoscopic urological surgery has been proven to be a viable alternative. Herein, we report on our initial experience of a laparoscopic nephroureterectomy with a concomitant cystoprostatectomy in 2 male uremic patients. Both of the patients had received a unilateral laparoscopic nephroureterectomy and transurethral resection of the bladder tumor (TUR-BT) due to urothelial carcinoma of upper urinary tract and bladder TCCs. Relapsing contralateral upper-tract cancer and bladder recurrence were noted during follow-up. A pure laparoscopic nephroureterectomy with a simultaneous laparoscopic radical cystoprostatectomy were performed in a single stage. The specimen was retrieved through a previous old Gibson incision. Patients were discharged in a stable condition on postoperative days 4 and 7, respectively. During 8 months of follow-up, there was no evidence of disease recurrence in either patient. Our initial experience suggests that a concomitant laparoscopic nephroureterectomy with a radical cystoprostatectomy is a safe, efficacious, and minimally invasive alternative for multifocal urothelial carcinoma in male uremic patients.
延伸閱讀
- Lu, C. Y., Yuan, H. B., Chang, W. K., Lui, P. W., & Lee, T. Y. (1999). 經尿道切開手術産生經尿道攝護腺刮除症候群併發急性心肌梗塞之病例報告. Acta Anaesthesiologica Sinica, 37(2), 105-108. https://doi.org/10.6955/AAS.199906.0105
- Hsu, J. M., Lo, K. Y., Lin, W. C., Chang, H. K., Chou, K., & Yang, S. (2001). 膀胱移形性上皮癌經尿道切除後在上泌尿道癌之發生：馬偕醫院的經驗. 中華民國泌尿科醫學會雜誌, 12(1), 32-37. https://doi.org/10.7024/JUAROC.200103.0032
- 洪啟峰（2015）。經尿道攝護腺刮除術後對攝護腺癌病患接受機械手臂輔助腹腔鏡攝護腺根除術術後結果研究〔碩士論文，中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834/CSMU.2015.00111
- Liao, A. C., Lin, V. C., Cheng, T. C., Chiu, A. W., & Lee, Y. H. (2005). 以全腹腔鏡腎臓輸尿管及膀胱袖切除來治療萎縮腎臓的腎盂腫瘤：病例報告及技術面考量. 臺灣泌尿科醫學會雜誌, 16(1), 25-30. https://www.airitilibrary.com/Article/Detail?DocID=10163220-200503-16-1-25-30-a
- Hsu, F. M., Cheng, J. C. H., Pu, Y. S., Lin, C. C., & Lai, M. K. (2006). 經尿道膀胱腫瘤切除術後之放射治療有無合併化學治療用於膀胱癌病患之膀胱保留療法：初步報告. 放射治療與腫瘤學, 13(2), 103-116. https://doi.org/10.6316/TRO/200613(2)103