单一体位腹腔镜肾输尿管全长+膀胱袖状切除术的临床效果和手术技巧  

Clinical effects and surgical techniques of single position laparoscopic nephroureterectomy

作　　者：贾博林 王明帅 杨飞亚 韩苏军 张勇 邢念增 Jia Bolin;Wang Mingshuai;Yang Feiya;Han Sujun;Zhang Yong;Xing Nianzeng(Departments of Urology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学中心/中国医学科学院,北京协和医学院肿瘤医院泌尿外科,北京100021

出　　处：《中华泌尿外科杂志》2022年第12期904-907,共4页Chinese Journal of Urology

摘　　要：目的探讨单一体位腹腔镜肾输尿管全长+膀胱袖状切除术的临床效果和手术技巧。方法回顾性分析2018年9月至2022年7月中国医学科学院肿瘤医院收治的84例上尿路尿路上皮癌患者的病例资料,男39例,女45例。年龄(64.9±9.3)岁。体质量指数(BMI)(24.7±3.4)kg/m^(2)。肿瘤位于左侧47例,右侧37例。84例均接受单一体位腹腔镜肾输尿管全长+膀胱袖状切除术,根据手术方式将患者分为2组,传统组67例,先行肾切除,然后沿输尿管行膀胱袖状切除术;改良组17例,先于肿瘤下方夹闭输尿管,行膀胱袖状切除,再沿输尿管向头侧游离,行肾切除。传统组和改良组的年龄[(65.5±9.4)岁与(62.7±8.9)岁]、BMI[(24.9±3.5)kg/m^(2)与(23.9±3.3)kg/m^(2)]、肿瘤侧别(左/右:38/29例与9/8例)、肿瘤位置(肾盂肾盏及上段输尿管/中段输尿管/下段输尿管:46/9/12例与13/2/2例)、肿瘤分期(T_(1~2)期/T_(3~4)期:54/13例与15/2例)的差异均无统计学意义(P>0.05)。比较两组的手术时间、估计出血量、术后肠道功能恢复时间、引流管拔除时间。结果本研究84例手术均顺利完成,无中转开放手术。手术时间(160.4±50.1)min,估计出血量(59.4±24.4)ml。术后中位肠道功能恢复时间1(1,2)d。4例未放置引流管,其余患者引流管拔除时间(4.8±1.9)d。所有患者均未发生Clavien-Dindo>3级并发症。传统组与改良组的手术时间[(159.2±52.9)min与(164.7±38.1)min]、估计出血量[(60.5±26.2)ml与(55.0±17.5)ml]、术后肠道功能恢复时间[1(1,2)d与2(1,2)d]、引流管拔除时间[(4.8±1.8)d与(5.2±2.0)d]差异均无统计学意义(P>0.05)。84例术后病理诊断均为尿路上皮癌,切缘均阴性。84例术后中位随访13(3,28)个月,失访5例,传统组膀胱复发5例,远处转移5例;改良组无膀胱复发,1例出现远处转移。结论单一体位腹腔镜肾输尿管全长+膀胱袖状切除术是治疗上尿路尿路上皮癌安全、有效的微创技术。术中先行膀�Objective To investigate the clinical effect and demonstrate the techniques of single position laparoscopic nephroureterectomy.Methods The clinical data of 84 upper urinary tract urothelial carcinoma patients admitted to the Cancer Hospital Chinese Academy of Medical Sciences from September 2018 to July 2022 were retrospectively analyzed,including 39 males and 45 females,with a median age of(64.9±9.3)years and mean BMI of(24.7±3.4)kg/m^(2).The tumor was located on the left side in 47 cases and the right side in 37 cases.All 84 patients received single position laparoscopic nephroureterectomy.According to different treatment methods,they were divided into two groups,including 67 cases undergoing nephrectomy first,and then bladder cuff excision was performed along ureter(traditional group),17 cases undergoing bladder cuff excision before clamping the ureter below the tumor,and then nephrectomy was performed along the ureter to the head side(modified group).There was no statistically significant in the comparison of age[(65.5±9.4)years vs.(62.7±8.9)years],BMI[(24.9±3.5)kg/m^(2)vs.(23.9±3.3)kg/m^(2)],left/right side tumor of(38/29 cases vs.9/8 cases),tumor location(in renal pelvis or calyx or upper/middle/lower ureter being 46/9/12 cases vs.13/2/2 cases)and tumor stage(T_(1-2)/T_(3-4):54/13 cases vs.15/2 cases)between traditional group and modified group(P>0.05).The operation time,estimate blood loss,postoperative intestinal function recovery time and postoperative drainage time were recorded and compared.Results All 84 cases were successfully completed without conversion to open surgery.The mean operation time was(160.4±50.1)min,the mean estimated blood loss was(59.4±24.4)ml,the median postoperative intestinal function recovery time was 1(1,2)d and the mean postoperative drainage time was(4.8±1.9)d(No drainage tube was placed in 4 patients).No Clavien Dindo>grade 3 complications occured.There was no significant difference in the comparison of operation time[(159.2±52.9)min vs.(164.7±38.1)min],estimate blo

关 键 词：腹腔镜 上尿路尿路上皮癌 肾输尿管切除术 单一体位 

分 类 号：R699[医药卫生—泌尿科学]