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BACKGROUND: Following renal transplantation, native renal pelvic or ureteral tumor occurs not only on one side, but also on both sides simultaneously or continuously.OBJECTIVE: To describe a new procedure in managing native renal pelvic or ureteral tumor, in which, retroperitoneal laparoscopic nephroureterectomy was first done followed by transurethral resection of ureteral orifice, and finally the kidney and the complete ureter with a bladder cuff were taken out through a midline abdomen incision, and to validate its feasibility.DESIGN, TIME AND SETTING: A technique modification experiment was performed at the Department of Urinary Surgery, Third Hospital, Peking University between July 2004 and March 2006.PARTICIPANTS: Eight patients (7 males and 1 female) with native renal pelvic or ureteral tumor who received laparoscopic nephroureterectomy with bladder cuff resection were included into this study. Of them, 4 cases had bilateral lesions. Laparoscopic nephroureterectomy with bladder cuff resection was conducted 12 times totally.METHODS: Retroperitoneal laparoscopic nephroureterectomy was first done in the lateral decubitus, followed by transurethral resection of the ureteral orifice with resectoscope in the lithotomy position, and finally, an incision was created in the lower midline abdomen to allow dissection of the distal ureter and bladder cuff and intact specimen extraction. Postoperatively, intravesical chemotherapy was routinely performed to prevent tumor recurrence. The patients were followed up at 3, 6, and 12 months after surgery, and once a year thereafter.MAIN OUTCOME MEASURES: Surgery time, blood loss volume, pathological report, tumor recurrence time, tumor-free survival time, and complications.RESULTS: The mean surgery time was 3.8 hours (range: 2.5-7 hours). The mean hemorrhage volume was 240 mL (range: 50-1 200 mL). Two cases needed blood transfusion, 600 and 1 000 mL, respectively. Transitional cell carcinoma grade Ⅲ was found in 3 cases, grade Ⅱ in 4 cases, and grade Ⅰ-Ⅱ in 4 cases. In addition, there was 1 case presenting with tumor breaking through the serous membrane of the ureter and 1 case suffering from poorly differentiated adenocarcinoma. The tumor recurred locally in one case 6 months after surgery, and the remaining cases all survived in a tumor-free state.CONCLUSION: After renal transplantation, laparoscopic nephroureterectomy with bladder cuff resection through a lower midline abdomen incision is feasible for treatment of native renal pelvic or ureteral tumor, with low tumor recurrence rate and satisfactory excision effects.
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Objective To evaluate the clinical experience of applying the combined tacrolimus (FK506) and mycophenolate mofetil (MMF) in simultaneous pancreas and kidney transplantation (SPKT) with bladder drainage of pancreatic secretion. Methods SPKT was performed for 14 consecutive patients. On the first day after transplantation, triple immunosuppression therapy was appliedwith FK506(0.07-0. 15 mg·kg-1·d-1), MMF(1.0- 1.5 g/d) and prednisone (25 mg/d). The FKS06 blood concentration after oral administration was assayed by the means of MEIA. The occurrence of rejection and the drug toxicity were monitored and recorded. Results Nine recipients survived with the grafts and their general conditions were well. They were followed up for 18--70 months (mean 34 months). There was no early stage complication such as pancreatic fistula and thrombosis after operation. The blood glucose level returned to normal range after operation. All recipients survived over 1 year. Of them, 3 cases survived for 1-3 years,1 case survived for 3-4 years, 1 case survived 4-5 years and 4 cases survived over 5 years. All the cases had normal blood glucose level and early graft function. Removal of allograft pancreas was performed on one patient because of hyperacute rejection. There were 4 cases died. Of whom, one case was diagnosed with duodenal stump leak 45 days after transplantation and he died of corrosive hemorrhage 7 months after operation. One patient died of unexpected heart disease. The 3rd patient died ol multiple organ failure and the fourth case died of acute rejection. Four cases with acute rejection, 2 cases with renal toxicity and 1 case with hepatotoxicity were observed. Conclusions The combination of TAC/MMF has synergetic effect. The application of this combination has good immunosuppression result. It could effectively reduce the risk of acute rejection and improve graft survival in SPKT recipients.
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We retrospectively analyzed the clinical data of 615 recipients (347 male and 268 female, age range: 9-75 years weighing 38-100 kg) who received renal transplantation in the Third Hospital of Peking University from January 2001 to July 200 to summarize the causes and experience of surgical complications after renal transplantation. Kidney of donors with brain death wa obtained using modified in situ hypothermy perfusion method, and kidney from living bodies was obtained using posterio abdominal cavity open or abdominal speculum method. After renal transplantation, the immunosuppressive therapy including FK50 or Cyclosporine A + mycophenolate mofetial or mizoribine + Prednisone was applied and regulated according to the variation o concentration in whole blood. Recipients were followed up for at 1 year. Of 615 patients, 29 cases developed surgical complication with the incidence rate of 4.72%; Graft lost in 5 cases due to surgical complications after renal transplantation. The achievement rati of operation was 99.19%.
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Objective To summarize the clinical experience of retroperitoneoscopic surgery in the treatment of adrenal tumors. Methods Retroperitoneoscopic resection of adrenal tumors was performed in 35 patients(12 males and 23 females) aged 25~72 years(mean,49.8 years).The tumor was left-sided in 15 patient and right-sided in 20 patients.There were 5 cases of pheochromocytoma,10 cases of primary hyperaldosteronism,2 cases of Cushing's disease,2 cases of paraganglioma,and 16 cases of dysfunctional adenoma.The operation was performed through 3 lumbar ports.A self-made water-filled balloon dilator was employed to expand the retroperitoneal cavity,and then the tumor was removed by using a harmonic scalpel.Results The procedure was successfully completed in all the 35 patients,with no need of conversions to open surgery.The intraoperative blood loss was 10~500 ml(mean,74 ml).No blood transfusion was required.The operation time was 45~200 min(mean,90 min).Conclusions Retroperitoneoscopic adrenalectomy has advantages of satisfactory effects,short operation time,little blood loss and invasion,and quick recovery.It can replace most of traditional open operations for adrenal tumors.
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Objective To summary the experience of diagnosis and treatment of transitional cell carcinoma of kidney recipients following renal transplantation.Methods From Jan. 2001 to July 2005, 600 kidney transplantations were performed and 9 patients were diagnosed as having renal tumors by B-ultrasound, IVU, cystoscopy, CT etc., including 3 cases of tumor of renal pelvis, 2 cases of tumor of ureter and 4 cases of tumor of cyst. Corresponding surgical operations were performed.Results All operations were successful and most patients got satisfactory results. Conclusion Kidney recipients have a higher rate of transitional cell carcinoma. Kidney recipients with hematuria should be examined carefully with cystoscopy, retrograde pyelography and cystourethroscopy.
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Objective To evaluate the efficacy of retroperitoneal laparoscopic radical nephrectomy.Methods A total of 126 patients underwent retroperitoneal laparoscopic radical nephrectomy from November 2002 to June 2006.The operation was performed through 3 lumbar ports.The renal artery and veins were blocked with the Hem-o-lok and then severed;the ureter was severed near the iliac blood vessel.Results A conversion to open surgery was required in 2 patients because of bleeding and in 1 patient because of severe adhesion.The mean operation time was 115 min(range,60~255 min) and the mean blood loss was 112ml(range,20~1000 ml).Blood transfusion was required in 2 patients.Complications occurred in 7 patients(spermatic vein injury in 1 patient,accessory renal artery injury in 1 patient,inferior vena cava injury in 1 patient,hemorrhage of renal artery stump in 1 patient,renal vein injury in 2 patients,and pancreatic tail injury in 1 patient).The patient with inferior vena cava injury was followed for 2 years and no abnormal findings were found.The patient with pancreatic tail leakage was followed for 1 year and no pancreatitis or liquid in the renal fossa was detected.The remaining 5 patients with complications presented no abnormal findings.The mean postoperative hospital stay was 5 days(range,4~8 days).Pathological results included renal clear cell carcinoma in 117 patients,cystic renal cell carcinoma in 3 patients,renal pelvis transitional cell carcinoma in 2 patients,chromophobe carcinoma in 1 patient,hamartoma in 2 patients,and oxyphil cell tumor in 1 patient.One patient developed a liver metastasis 6 months after operation,and died 1 year after operation.The rest of 125 patients were followed for a mean of 27 months(range,1~43 months),and survived without renal fossa or incision metastasis,or distant recurrence.Conclusions Retroperitoneal laparoscopic radical nephrectomy is a safe,reliable,and effective technique for renal tumors.