UTUC腹腔镜下根治性切除术联合LND的回顾性分析  

Retrospective Analysis of UTUC Laparoscopic Radical Resection Combined with LND

作　　者：冯坤 宋丁铭 陈华进 李航旭 朱佳宝 金艳阳 Feng Kun;Song Dingming;Chen Huajin;Li Hangxu;Zhu Jiabao;Jin Yanyang(The First Affiliated Hospital of Jinzhou Medical University;The ThirdAffiliated Hospital of Jinzhou Medical University;Jinzhou Medical University,Jinzhou 121000 China)

机构地区：[1]锦州医科大学附属第一医院 [2]锦州医科大学附属第三医院 [3]锦州医科大学,辽宁锦州121000

出　　处：《锦州医科大学学报》2024年第4期66-71,共6页Journal of Jinzhou Medical University

基　　金：辽宁省教育厅基金项目,项目编号:JYTJCZR2020063。

摘　　要：目的探讨经腹一体位腹腔镜下肾盂输尿管根治性切除术联合区域淋巴结清扫术(lymph node dissectio,LND)的临床有效性。方法选取2018年1月至2023年1月在锦州医科大学附属第一医院确诊且行手术治的42例输尿管癌患者作为研究对象。对所有患者行腹腔镜肾盂输尿管切除术联合膀胱袖状切除术,对术前符合淋巴结清扫术指征的患者行淋巴结清扫术。收集患者的人口学特征、围术期结果、术后并发症等。结果患者中位年龄63岁(55~70岁),42例患者均顺利完成手术,术中无病例转为开放式手术,其中14例患者术中更改体位,23例患者行LND,围术期无病例死亡,中位手术时间220 min(199~245 min),中位术中出血量128 mL(101~157 mL),术后引流管引流量62 mL(51~97 mL),术后放置引流管中位时间3 d,术后出现并发症8例。经过术后平均两年时间随访,患者均存活,无转移或复发病例。结论经腹一体位腹腔镜下治疗上尿路尿路上皮癌较传统术式具有手术时间短、方式简洁、术后康复快等优点,值得进一步推广,联合淋巴结清扫术可明确病理分期,但未行淋巴结清扫术(nolymph node dissection,NLND)组的部分围术期指标优于LND组。Objective To investigate the clinical effectiveness of laparoscopic ureteropyelotomy combined and treated with surgery with regional lymph node dissection.Methods From January 2018 to January 2023,42 patients with ureteral cancer were selected from the First Affiliated Hospital of Jinzhou Medical University.Laparoscopic pyeloureterectomy plus sleeve resection of bladder were performed on all patients.Lymph node dissection was performed on patients who met the indications for lymph node dissection before surgery.The demographic characteristics,perioperative results and postoperative complications of the patients were collected.Results The median age of the patients was 63 years old(55~70 years old),all 42 patients successfully completed the operation,and no cases were converted to open surgery during the operation,among which 14 patients changed their position during the operation,23 patients underwent LND,and no cases died during the perioperative period.The median operation time was 220 min(199~245 min).The median intraoperative blood loss was 128 mL(101~157 mL),the postoperative drainage volume was 62 mL(51~97 mL),and the median placement time of the drainage tube was 3 days.There were 8 postoperative complications.After a mean follow-up of two years,all patients survived without metastasis or recurrence.Conclusion Compared with the traditional operation,the integrated laparoscopic treatment of upper urinary tract urothelial carcinoma has the advantages of short operation time,simple mode and rapid postoperative recovery,which is worthy of further promotion.The combined lymph node dissection can determine the pathological stage,but some perioperative indexes in the NLND group are better than those in the LND group.

关 键 词：上尿路尿路上皮癌 淋巴结清扫术 腹腔镜下手术 经腹一体位 

分 类 号：R694[医药卫生—泌尿科学]