根治性肾输尿管切除术的两种术式疗效比较  

Comparison of two operations for the treatment of radical nephroureterectomy

作　　者：汪洋[1] 夏勇[1] 李学松[2] 方冬[2] 张战宏[1] 拓志勇 邵林海[1] 白杨开 胡新红[1] 王叶松[1] 朱元宏 Wang Yang;Xia Yong;Li Xuesong;Fang Dong;Zhang Zhanhong;Tuo Zhiyong;Shao Linhai;Bai Yangkai;Hu Xinhong;Wang Yesong;Zhu Yuanhong(Department of Urology,Hanzhong Central Hospital,Hanzhong 723000,China;Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,National Urological Cancer Center,Beijing100034,China)

机构地区：[1]陕西省汉中市中心医院泌尿外科,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,100034

出　　处：《中华腔镜泌尿外科杂志（电子版）》2022年第6期518-522,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：陕西省2021年重点研发计划项目(2021SF-268)。

摘　　要：目的探讨微创手术治疗肾盂输尿管癌的方法。方法回顾性分析2017年9月至2021年10月在汉中市中心医院接受两种不同手术方式治疗肾孟及输尿管癌的病例共60例,其中经腹腹腔镜一体位肾输尿管全长切除联合使用定制的哈巴狗钳行膀胱袖状切除术30例(改良组),后腹腔镜结合下腹部斜切口行根治性肾输尿管切除术30例(传统组)。比较两组患者围手术期资料及随访结果。结果两组中所有患者都顺利完成手术,改良组手术时间、术中出血量、术后引流量、术后引流管保留时间和术后住院时间均少于传统组,差异具有统计学意义(P<0.05)。两组术后下床活动时间、肠功能恢复时间、术后膀胱肿瘤复发和随访时间比较,差异无统计学意义(P>0.05)。所有患者均随访1~48个月,膀胱肿瘤复发共8例,其中改良组2例,传统组6例,行经尿道膀胱肿瘤电切术治愈,其余均无瘤生存。结论完全经腹腹腔镜一体位肾输尿管全长切除联合使用定制的哈巴狗钳行膀胱袖状切除术更加符合肿瘤根治原则,是一种安全、微创、可行、有效的方法,适合临床推广。Objective To investigate the minimal invasive surgery for upper tract urothelial carcinoma(UTUC).MethodsThe data of 60 patients with UTUC who underwent two different surgical methods in our hospital from Sep.2017 to Oct.2021 were analyzed retrospectively.30 cases(modified group)received complete transperitoneal laparoscopic nephroureterectomy with a single body position and distal ureter resection using a custom-made antislip laparoscopic bulldog clamp,while 30 cases(traditional group)was treated with radical retroperitoneal laparoscope nephroureterectomy plus open-surgery bladder sleeve resection combined with lower abdominal oblique incision.The perioperative data and follow-up results of the two groups were analyzed.ResultsAll surgeries of the two groups were successfully completed.The operation time,hemorrhage volume,the amount of postoperative drainage,drainage tube removal time and postoperative hospital stay in the modified group were all shorter than those in the traditional group,with statistical significance(P<0.05).There was no significant difference in the leaving time,the recovery time of postoperative gastrointestinal function,postoperative bladder tumor recurrence and follow-up time between the two groups (P>0.05). All patients were followed up for 1-48 months. A total of 8 cases ofbladder tumor recurrence, including 2 cases in modified group and 6 cases in traditional group, were treatedby transurethral resection of bladder tumor, and the rest were tumour-free. Conclusion Transperitoneal laparoscopic nephroureterectomy with a single body position and distal ureter resection using a custommade laparoscopic bulldog clamp is more consistent with the principle of radical treatment of tumors. Itis a safe, minimally invasive, feasible and effective method, which is suitable for promotion in clinical.

关 键 词：腹腔镜 肾输尿管全长切除术 特制防滑哈巴狗钳 肾盂癌 输尿管癌 

分 类 号：R737.1[医药卫生—肿瘤]