腹腔镜上尿路尿路上皮癌根治术中经膀胱与经膀胱外入路膀胱袖状切除术的疗效比较  

Intravesical Versus Extravesical Approach in Bladder Cuff Excision in Laparoscopic Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

作　　者：卞戈 张明[1] 杨为杰 迟长亮[1] 邢栋[1] 田静岩[1] 郑佐柱[1] 王晓庆[1] Bian Ge;Zhang Ming;Yang Weijie(Department of Urology,First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院泌尿外科,长春130021

出　　处：《中国微创外科杂志》2022年第11期879-883,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：吉林省科技厅支撑平台-吉林省临床医学研究中心项目(20190905001SF)。

摘　　要：目的探讨腹腔镜上尿路尿路上皮癌根治术中经膀胱与经膀胱外的膀胱袖状切除的效果。方法回顾性分析2019年11月~2022年3月49例单一体位完全腹腔镜上尿路尿路上皮癌根治术的临床资料。肾盂肿瘤22例,输尿管肿瘤27例。26例行经膀胱途径,23例行经膀胱外途径。2组年龄、性别、肿瘤部位、膀胱癌病史、病理肿瘤分期和分级差异无统计学意义(P>0.05)。手术均由同一术者完成。比较2组术中及术后指标。结果经膀胱组手术时间长于经膀胱外组(172.1±23.1)min vs.(152.0±23.9)min,P=0.004),2组术中出血量及并发症发生率差异无统计学意义(P>0.05)。中位随访时间15(6~30)个月。共16例复发或转移。经膀胱组和经膀胱外组2年无复发生存率(64.8%vs.62.4%,log rankχ^(2)=0.039,P=0.844)和2年无膀胱复发生存率(73.4%vs.74.3%,log rankχ^(2)=0.021,P=0.886)差异均无统计学意义。结论经膀胱途径膀胱袖状切除可完全切除输尿管壁内段,可能降低切除不充分致肿瘤复发的风险。Objective To compare clinical results of intravesical versus extravesical approach in bladder cuff excision during laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma(UTUC).Methods Clinical data of 49 UTUC patients who received laparoscopic radical nephroureterectomy in one position between November 2019 and March 2022 were retrospectively reviewed,including renal pelvis tumor in 22 cases and ureteral tumor in 27 cases.All the excisions of bladder cuff were performed with laparoscopic techniques,either by intravesical approach(n=26)or by extravesical approach(n=23).There were no significant differences in age,gender,tumor location,primary bladder cancer history,tumor pathologic grade and stage between the two groups(P>0.05).All the operations were performed by the same operator.The intraoperative and postoperative indexes and surgical outcomes were compared between the two groups.Results The mean operative time was longer in the intravesical group than in the extravesical group[(172.1±23.1)min vs.(152.0±23.9)min,P=0.004].The estimated blood loss and the complication rate were similar between the two groups(P>0.05).The median follow-up time was 15 months(range,6-30 months).A total of 16 patients experienced recurrence or metastasis.The 2-year recurrence-free survival rate and the 2-year intravesical recurrence-free survival rate were similar between the two groups(64.8%vs.62.4%,log rankχ^(2)=0.039,P=0.844;73.4%vs.74.3%,log rankχ^(2)=0.021,P=0.886).Conclusion Intravesical sleeve resection can completely remove the inner segment of ureter wall,which may reduce the risk of tumor recurrence due to inadequate resection.

关 键 词：上尿路尿路上皮癌 腹腔镜手术 肾输尿管切除术 膀胱袖状切除术 肿瘤复发 

分 类 号：R737.1[医药卫生—肿瘤]