经腹腹腔镜单一体位肾输尿管全长切除术治疗上尿路尿路上皮癌  

Transperitoneal laparoscopic nephroureterectomy with a single body position for upper tract urothelial carcinoma

作　　者：汪洋[1] 邵林海[1] 白杨开 李学松[2] 方冬[2] 夏勇[1] 张战宏[1] 拓志勇 兰海河 王亚佟[1] 赵超群[1] 何宁 WANG Yang;SHAO Linhai;BAI Yangkai;LI Xuesong;FANG Dong;XIA Yong;ZHANG Zhanhong;TUO Zhiyong;LAN Haihe;WANG Yatong;ZHAO Chaoqun;HE Ning(Department of Urology,Hanzhong Central Hospital,Hanzhong 723000;Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,National Urological Cancer Center,Beijing 100034,China)

机构地区：[1]陕西省汉中市中心医院泌尿外科,陕西汉中723000 [2]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿男性生殖系肿瘤研究中心,北京100034

出　　处：《现代泌尿外科杂志》2021年第11期909-913,共5页Journal of Modern Urology

基　　金：陕西省2021年重点研发计划项目资助(No.2021SF-268)。

摘　　要：目的探讨完全经腹腹腔镜一体位肾输尿管全长切除,使用特制防滑哈巴狗钳夹闭输尿管末端膀胱袖口部切除术的有效性和安全性。方法回顾性分析2018年2月至2021年4月在汉中市中心医院入院治疗的上尿路尿路上皮癌(UTUC)患者32例,其中16例接受经腹腹腔镜一体位肾输尿管全长切除术,使用定制的哈巴狗钳改良输尿管末端切除术(改良组),另16例行联合尿道电切镜、腹腔后镜行肾输尿管切除术(传统组)。统计两组患者手术时间、术中出血量、术后引流量等围手术期资料及随访结果。结果两组32例患者手术均顺利完成,改良组在手术时间、术中出血量、术后引流量、术后拔除引流管时间、术后拔除尿管时间方面均优于传统组,差异有统计学意义(P<0.05)。所有患者均随访1~28个月,传统组随访患者中见继发膀胱肿瘤2例,两组术后随访时间及术后膀胱肿瘤复发差异无统计学意义(P>0.05),其余均无瘤生存。结论经腹腹腔镜一体位肾输尿管全长切除治疗UTUC,肿瘤控制结果满意,是一种安全、微创、有效、可行的方法,值得在临床上进一步推广。Objective To investigate the efficacy and safety of complete transperitoneal laparoscopic nephroureterectomy and distal ureter resection using a custom-made antislip laparoscopic bulldog clamp.Methods Clinical data of 32 upper tract urothelial carcinoma(UTUC)cases treated in Hanzhong Central Hospital during Feb.2018 and Apr.2021 were retrospectively analyzed,including 16 cases treated with complete transperitoneal laparoscopic nephroureterectomy and distal ureter resection using a custom-made antislip bulldog clamp(modified group),and another 16 cases treated with retroperitoneal laparoscope combined with transurethral electrotomy(traditional group).The perioperative data such as operation time,blood loss,posto-perative drainage volume and follow-up results of the two groups were analyzed.Results All operations were successful.The modified group had shorter operation time,less blood loss,less amount of postoperative drainage,and shorter drainage tube and catheter removal time(P<0.05).During the follow-up of 1 to 28 months,2 cases in the traditional group had recurrence,and there was no statistical significance in postoperative follow-up time and recurrence between the two groups(P>0.05).The other 30 cases survived free of tumor.Conclusion Transperitoneal laparoscopic nephroureterectomy with a single body position for the treatment of UTUC yields satisfactory tumor control results.It is a safe,minimally invasive,effective and feasible method worthy of clinical promotion.

关 键 词：上尿路尿路上皮癌 手术技术改良 经腹腹腔镜 单一体位 肾输尿管全长切除术 器械改良 防滑哈巴狗钳 

分 类 号：R737.1[医药卫生—肿瘤]