后腹腔镜联合经尿道电切与下腹斜切口治疗上尿路尿路上皮癌的对照研究  

Transurethral ureteral orifice resection versus open resection after retroperitoneal laparoscopic nephroureterectomy for upper urinary urothelial carcinoma:a clinical control study of 59 cases

作　　者：廖德洋 周晓洲 付坚 刘洋 李珍燕 王永权 周占松 LIAO Deyang;ZHOU Xiaozhou;FU Jian;LIU Yang;LI Zhenyan;WANG Yongquan;ZHOU Zhansong(Department of Urology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院泌尿外科,重庆400038

出　　处：《第三军医大学学报》2021年第8期761-765,共5页Journal of Third Military Medical University

基　　金：陆军军医大学临床医学科研人才培养计划(2018XLC3006)。

摘　　要：目的探讨后腹腔镜联合经尿道输尿管口电切治疗上尿路尿路上皮癌(upper urinary tract urothelial carcinoma,UTUC)的安全性与有效性。方法收集2016年7月至2019年7月本院采用后腹腔镜联合下腹部斜切口(下腹切口组)或后腹腔镜联合经尿道输尿管口电切(电切组)治疗UTUC患者的临床资料。其中下腹部切口组39例,电切组20例,共59例。比较两组手术时间、术中出血量、肠道功能恢复时间、留置引流时间、术后住院时间、术后并发症及1年复发转移率等指标。结果电切组手术时间长于下腹切口组,差异有统计学意义(219.1±54.2 vs 178.7±60.8 min,P<0.05)。电切组留置引流时间、肠道功能恢复时间、术后住院时间均较下腹切口组显著缩短(P<0.05)。下腹切口组术后并发症共4例,其中肺部感染2例,腹膜后积液1例,术区淋巴漏1例;电切组术后出现膀胱出血1例,行二次膀胱电切镜止血。两组其余指标比较无明显差异。结论后腹腔镜联合经尿道输尿管口电切治疗上尿路尿路上皮癌是安全、有效的。相对于后腹腔镜联合下腹部斜切口术式,具有创伤小,恢复快的优势。Objective To evaluate the safety and effectiveness of retroperitoneal laparoscopic nephroureterectomy combined with transurethral resection of the ureteral orifice for the treatment of upper urinary urothelial carcinoma(UTUC).Methods We retrospectively analyzed the clinical data of 59 UTUC cases treated in our hospital from July 2013 to July 2019,who underwent retroperitoneal laparoscopic nephroureterectomy combined with transurethral resection of the ureteral orifice(n=20)or abdominal incision(n=39).Blood loss volume,time of incision drainage,recovery time of postoperative intestinal function,postoperative hospitalization time,postoperative complications and local recurrence,and distant metastasis were compared between the 2 groups.Results The transurethral resection group had significantly longer operative time(219.1±54.2 vs 178.7±60.8 min,P<0.05),but shorter time of incision drainage,recovery time of postoperative intestinal function and postoperative hospitalization time(P<0.05)when compared with the abdominal incision group.There were 4 cases having operative complications in the abdominal incision group,including 2 cases of pulmonary infection,1 case of retroperitoneal effusion,and 1 case of lymphorrhagia.In the transurethral resection group,there was 1 case of postoperative bladder bleeding,and cystoscopic electrocision was performed for hemostasis.No significant differences were found in other evaluated indicators between the 2 groups.Conclusion Retroperitoneal laparoscopic nephroureterectomy combined with resection of the ureteral orifice is safe and effective for the treatment of UTUC.Compared with abdominal incision,transurethral approach has the advantage of less trauma and rapider recovery.

关 键 词：后腹腔镜 经尿道输尿管口电切 肾盂癌 输尿管癌 

分 类 号：R730.56[医药卫生—肿瘤] R737.11[医药卫生—临床医学]