改良经腹途径腹腔镜下单一体位肾输尿管全长切除术的临床应用  

Clinical application of modified transperitoneal laparoscopic nephroureterectomy with a single body position

作　　者：汪洋[1] 夏勇[1] 方冬[2] 李学松[2] 张战宏[1] 拓志勇 邵林海[1] 白杨开 WANG Yang;XIA Yong;FANG Dong;LI Xuesong;ZHANG Zhanhong;TUO Zhiyong;SHAO Linhai;BAI Yangkai(Department of Urology,Hanzhong Central Hospital,Hanzhong,Shaanxi,723000,China;Department of Urology,Peking University First Hospital,Peking University Institute of Urology,National Urological Cancer Center)

机构地区：[1]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

出　　处：《临床泌尿外科杂志》2022年第2期114-118,共5页Journal of Clinical Urology

基　　金：陕西省2021年重点研发计划项目(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以及输尿管末端使用定制的防滑哈巴狗钳切除的手术方法和临床价值。方法:回顾性分析2018年2月—2021年3月在汉中市中心医院接受经腹腹腔镜一体位肾输尿管全长切除术的16例上尿路尿路上皮癌患者的临床资料。改良腹腔镜手术方式,术中患者无须改换体位,改良手术器械,用特制防滑哈巴狗钳夹闭膀胱袖口状切除,将膀胱切口用1-0可吸收线连续缝合。结果:本组病例均手术顺利,手术时间130~290 min,平均(187.5±37.7)min;术中失血量30~180 mL,平均(83.1±40.6)mL。术后病理诊断均为尿路上皮癌,低级别5例,高级别11例。所有患者随访1~27个月,均无瘤生存。结论:改良全腹腔镜一体位肾输尿管全长切除术更加符合肿瘤根治原则,具有手术步骤简洁、安全有效、恢复快、减少并发症的优点,具有推广应用价值。Objective:To evaluate the operative method and clinical value of complete transperitoneal laparoscopic nephroureterectomy and distal ureter resection using a custom-made antislip laparoscopic bulldog clamp.Methods:From February 2018 to March 2021,we retrospectively analyzed 16 patients with upper tract urothelial carcinoma who underwent complete transperitoneal laparoscopic nephroureterectomy in Hanzhong Central Hospital.The modified surgical method and instrument includes the bladder cuff resection with a special large clamp and suturing the bladder incision by running closure using 1-0 absorbable suture without repositioning the patient during the operation.Results:The operations were all successful in 16 cases.The mean operative time was(187.5±37.7)min,ranging from 130 to 290 minutes,and the intraoperative blood loss was(83.1±40.6)mL,ranging from 30 to 180 mL.Pathological results showed urothelial carcinoma in all cases,including 5 cases of low grade and 11 cases of high grade.All patients who were followed up for 1 to 27 months survived free of tumor.Conclusion:Modified complete transperitoneal laparoscopic nephroureterectomy is more in line with the principle of cancer radical cure.It has the advantages of simple procedure,safety and effectiveness,rapid recovery and less complications.It is worthy of spread and application.

关 键 词：上尿路尿路上皮癌 改良经腹腹腔镜 肾输尿管全长切除术 手术器械改良 特制防滑哈巴狗钳 

分 类 号：R737.1[医药卫生—肿瘤]