改良体位完全经腹腹腔镜肾盂输尿管癌根治术临床疗效观察  

Clinical Effect of Modified Posture Total Transabdominal Laparoscopic Radical Nephrectomy for Renal Pelvic and Ureteral Carcinoma

作　　者：李文永 薛胜[1] 张家俊[1] 陈志军[1] 王成勇[1] 代昌远 关翰 李庆文[1] LI Wen-yong;XUE Sheng;ZHANG Jia-jun;CHEN Zhi-jun;WANG Cheng-yong;DAI Chang-yuan;GUAN Han;LI Qing-wen(Department of Urology,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233000,China)

机构地区：[1]蚌埠医学院第一附属医院泌尿外科,安徽蚌埠233000

出　　处：《河北北方学院学报（自然科学版）》2021年第6期19-22,25,共5页Journal of Hebei North University:Natural Science Edition

基　　金：蚌埠医学院自然科学重点项目(No.BYKY2019035ZD);蚌埠市科技创新指导类项目(No.20180317)。

摘　　要：目的探讨改良体位完全经腹腹腔镜肾盂输尿管癌根治术的临床应用价值。方法回顾性分析78例因肾盂癌或输尿管癌行腹腔镜根治术患者的围术期及随访资料,其中38例患者行经腹腹腔镜下患侧肾、输尿管全段加膀胱袖套状切除术(A组),手术采用4孔改良体位,先行腹腔镜下根治性肾+输尿管中上段切除,然后变换操作通道,镜头转向盆腔行输尿管下段及膀胱袖套状切除;40例患者行后腹腔镜下患侧肾+输尿管切除+开放膀胱袖套状切除术(B组),先采用三孔法后腹腔镜下切除肾脏及大部分输尿管,再换取平卧位,于患侧下腹部取斜切口行膀胱袖套状切除。患者术后均予以膀胱灌注或全身化疗。结果所有患者均顺利完成手术,术后病理证实均为尿路上皮癌。A组手术时间(125.3±45.4)min、手术失血量(70.5±56.6)mL、术后肠道功能恢复时间(3.1±1.6)d、术后引流管拔除时间(4.2±1.8)d、术后住院时间(6.9±1.9)d;B组手术时间(160.4±67.5)min、手术失血量(112.3±84.9)mL、术后肠道功能恢复时间(2.7±1.3)d、术后引流管拔除时间(4.5±1.1)d、术后住院时间(7.3±1.7)。A组手术时间及手术失血量均少于B组,差异有统计学意义(P<0.05);患者术后均无明显并发症发生;随访6~48月,随访期间,A组1例患者出现膀胱内复发,B组2例患者出现膀胱内复发。结论改良体位完全经腹腹腔镜下肾盂输尿管癌根治术操作简便、创伤小、并发症发生率低且控瘤效果满意,值得临床应用推广。Objective To investigate the clinical application value of modified posture total transabdominal laparoscopic radical nephrectomy for renal pelvic and ureteral carcinoma.Methods The perioperative and follow-up data of 78 patients with renal pelvic or ureteral cancer who underwent laparoscopic radical nephrectomy for renal pelvic or ureteral cancer were collected.Among them,38 patients in group A underwent transabdominal laparoscopic radical nephrectomy of the affected side of the kidney and ureter,and the operation was performed with 4-hole modified posture and laparoscopic radical kidney+ureter.The upper middle segment was resected,and then the operation channel was changed.The lens was turned to the pelvic cavity for the lower ureteral segment and bladder sleeve resection.In group B,40 patients underwent retroperitoneoscopic nephrectomy+ureterectomy+open bladder sleeve resection.The kidney and most of ureters were removed by three port method,and then the patients were replaced by recumbent position,and the bladder sleeve resection was performed by oblique incision in the lower abdomen of the affected side;both groups were given bladder perfusion or systemic chemotherapy after operation.Results All the operations were successfully completed,and all cases were pathologically confirmed as urothelial carcinoma.In group A,the operation time was(125.3±45.4)min,the blood loss(70.5±56.6)ml,the recovery time of intestinal function(3.1±1.6)d,the drainage tube extraction time(4.2±1.8)d,and the postoperative hospital stay(6.9±1.9)D.In group B,the operation time was(160.4±67.5)min,the blood loss(112.3±84.9)ml,the recovery time of intestinal function(2.7±1.3)d,the drainage tube extraction time(4.5±1.1)d,and the postoperative hospital stay(7.3±1.7)d.The operation time and blood loss in group A were less than those in group B,and the difference was statistically significant(P<0.05);there were no obvious complications in both groups;the follow-up time was 6-48 months,with a median time of 27 months.During the follow-

关 键 词：改良体位 腹腔镜 肾盂输尿管癌 

分 类 号：R737.13[医药卫生—肿瘤]