联合腔镜与全腹腔镜治疗上尿路移行细胞癌的比较研究  

Comparative evaluation of retroperitoneal laparoscopy with urethral resectoscope and total retroperitoneal laparoscopy for upper urinary tract transitional cell carcinoma

作　　者：孙士恒[1] 楚宁[1] 王俊波[1] 卢德祥[1] 

机构地区：[1]黑龙江省医院泌尿外科,黑龙江哈尔滨150036

出　　处：《黑龙江医药科学》2012年第2期18-19,共2页Heilongjiang Medicine and Pharmacy

摘　　要：目的:比较腹腔镜联合电切镜与全腹腔镜在治疗上肾盂、输尿管上段移行细胞癌的临床效果。方法:总结我院2005—01-2007—06治疗肾盂、输尿管上段移性细胞癌27例,其中腹膜后全腹腔镜行肾输尿管及膀胱袖状切除者12例,另15例采用腹膜后腹腔镜行肾切除,于输尿管离断处远端插入椎形输尿管扩张器逆行将输尿管翻入膀胱,用电切镜于膀胱内行输尿管及膀胱部分袖状切除。如果膀胱内有肿瘤种植,可以同时切除膀胱内的肿瘤。对两组的手术时间、手术复杂性、治疗效果、并发症等的比较研究。结果:联合腔镜组平均治疗时间(150.6±40.8)m in,平均出血量(80.0±35.9)mL,平均保留腹膜后引流管时间(2.7±0.5)d,平均住院天数(7.2±1.9)d,平均住院费用(18,593±1060)元。全腹腔镜组手术时间(210.8±25.4)m in,出血量在(230.4±56.5)mL,平均保留腹膜后引流管时间(6.2±2.3)d,平均住院天数(12.4±6.0)d,平均住院费用(16,977±5105)元。全组12例中有不同程度的尿外渗者3例。结论:腹腔镜联合电切镜治疗上尿路移性细胞癌,手术无需腹膜后的广泛分离,出血量少,不用腹腔镜下缝合膀胱壁,早期闭合输尿管减少了肿瘤种植的机会,全组均没有发生尿外渗,值得在临床推广使用。Objective：To compare the clinical outcomes of laparoscopic with urethral resectoscope and total retroperitoneal laparoscopy for upper tract transitional cell carcinoma.Methods：Our hospital summarizes 27cases on the treatment of upper urinary tract transitional cell carcinoma.Among them there are 12 patients who were made nephroureterectomy and excision of urinary bladder cuff by retroperitoneal laparoscope.15 patients were made rephrectomy by retroperitoneal laparoscope and inserted the conoid ureteric dilator at the far end of cutting of ureter to turn the ureter into urinary bladder in antidromic way,then made urteretomy and excision of urinary bladder cuff inside urinary bladder by urethral resetoscope.Meanwhile,a tumor growing in urinary bladder can be made electrocision.Comparative study is made on the length of operation time,complexity,curative effect and complication of the two groups.Results：In the combined laparoscope group,the mean operative time is（150.6±30.8） min,the mean blood loss is（80.0±12.9） mL,the mean time of standing drainage tube is（2.7±0.5） d,the mean hospital stay（7.2±1.9）d and the mean expenditure（17,593±1,060） yuan.In the total laparoscopy group,the mean operative time is（210.8±25.4）min,the mean blood loss is（230.4±26.5）mL,the mean time of standing drainage tube is（6.2±1.3）d,the mean hospital stay is（14.4±2.2）d and the mean expenditure is（16,977.±1105）yuan. 3 patients suffered from urinous infiltration of various levels.Conclusions：The laparoscopic with urethral resectoscope nephroureterectomy which neither needs to widen retroperitoneal separation,nor to suture the wall of urinary bladder,less bleeding and less complications.Due to the advantages,the operation is worthy of being applied.

关 键 词：肾输尿管切除术 移行细胞癌 腹腔镜 电切 

分 类 号：R737.11[医药卫生—肿瘤]