经腹腹腔镜与后腹腔镜治疗上尿路尿路上皮癌的比较研究  

Transperitoneal Versus Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

作　　者：袁道彰[1] 都兴华[2] 石利平[2] 李靖[1] 郑舜升 王斌[1] 杨建安[1] 苏泽轩[2] 

机构地区：[1]广州医科大学附属肿瘤医院泌尿外科,广州510095 [2]暨南大学附属第一医院泌尿外科,广州510630

出　　处：《中国微创外科杂志》2016年第9期812-815,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨完全腹腔镜下肾输尿管全长切除、膀胱袖状切除术治疗上尿路尿路上皮癌的有效性和安全性。方法回顾性分析2010年10月~2015年10月上尿路尿路上皮癌79例资料,其中经腹完全腹腔镜下肾输尿管全长切除及膀胱袖状切除术47例（CTLNU组）,后腹腔镜肾输尿管全长切除＋下腹部小切口膀胱袖状切除术32例（RLNU组）。记录手术时间、术中出血量、术后肛门排气时间和术后住院时间。结果与RLNU组相比,CTLNU组手术时间短[（120.5±21.6）min vs.（145.2±29.9）min,t=-4.265,P=0.000],术中出血量少[（120.8±42.4）ml vs.（190.6±60.8）ml,t=-6.017,P=0.000],术后住院时间短[（8.2±2.5）d vs.（9.9±3.2）d,t=-2.646,P=0.010];术后肛门排气时间差异无统计学意义（P〉0.05）。CTLNU组和RLNU组随访发现膀胱尿路上皮癌分别为5例和3例（P〉0.05）,行经尿道膀胱肿瘤电切术治愈,远处转移分别为2例和3例（P〉0.05）。结论完全腹腔镜下肾输尿管全长切除、膀胱袖状切除术是治疗上尿路尿路上皮癌的可行、安全、有效的微创方法。Objective To evaluate the effectiveness and safety of complete transperitoneal laparoscopic nephroureterectomy （CTLNU） for upper tract urothelial carcinoma （UTUC）. Methods Between 0etober 2010 and Oetober 2015, a total of 79 patients with UTUC were assigned to receive either CTLNU （ CTLNU group, n = 47 ） or retroperitoneal laparoscopic nephroureterectorny （ RLNU group,n = 32）. The operation time, intraoperative blood loss, postoperative anal exhaust time, and number of postoperative hospitalization days were recorded. Results As compared with the RLNU group, the operation time was significantly shorter in the CTLNU group [ （120.5 ±21. 6） rain vs. （145. 2 ±29. 9） rain, t = -4. 265, P = 0. 000], the intraoperative blood loss was significantly less in the CTLNU group [ （120.8 ±42.4） rnl vs. （190.6 ±60.8） ml, t = -6.017, P =0.000], and the number of postoperative hospitalization clays was significantly lower in the CTLNU group [ （ 8.2±_ 2.5） d vs. （9.9 ± 3.2） d, t = - 2. 646, P = 0. 010] . Whereas there was no significant difference in postoperative anal exhaust time between the two groups （P 〉 0.05）. There were 5 eases and 3 eases of urinary bladder epithelial cell carcinoma in the CTLNU group and the RLNU group during the follow-up, respectively （P 〉 0.05 ） , which were treated with bladder tumor transurethral resection. Distant metastasis was found in 2 cases in the CTLNU group and 3 eases in the RLNU group （ P 〉 0.05 ）. Conclusion Complete transperitoneal laparoseopic nephrouretereetomy is a minimally invasive, feasible, safe and effective way to treat UTUC.

关 键 词：腹腔镜 尿路上皮癌 输尿管肿瘤 

分 类 号：R737.1[医药卫生—肿瘤]