经腹腔入路一体位肾输尿管全长切除术的临床应用研究  

Clinical application of transabdominal laparoscopic radical nephroureterectomy with a single posture

作　　者：王林 庞鹏 吴磊 李国庆 WANG Lin;PANG Peng;WU Lei(Department of Urology,General Hospital of Pingmei Shenma Group,Pingdingshan 467000,China)

机构地区：[1]平煤神马医疗集团总医院泌尿外科,河南平顶山467000

出　　处：《腹腔镜外科杂志》2024年第9期692-696,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨经腹腔入路一体位肾输尿管全长切除术治疗高危上尿路尿路上皮癌的安全性与有效性。方法:纳入2019年8月至2022年12月行腹腔镜经腹腔入路一体位肾输尿管全长切除术的66例上尿路尿路上皮癌患者,术中均预防性膀胱灌注30 mg吡柔比星30 min,手术由同一术者采取同一手术策略连续完成,收集患者围手术期指标、病理结果及术后随访资料,并总结手术技巧、手术步骤及操作流程。结果:手术均顺利完成,无一例中转开放手术,术中未发生大出血、血管损伤及肠道破裂等并发症。手术时间平均(145.4±57.3)min,术中出血量(126.2±37.6)mL,术后排气时间(26.4±4.2)h,术后进食时间(27.1±4.5)h,术后下床活动时间(28.3±5.1)h,术区引流管拔除时间4.0(3.8,6.0)d,中位住院时间6.0(5.0,7.0)d。术后随访16.5(11.0,25.6)个月,术后≥T_(2)期患者行3~6周期GC方案化疗,均未行预防性膀胱灌注,随访期间无肿瘤复发或远处转移。结论:腹腔镜经腹腔入路一体位肾输尿管全长切除术在手术时间、麻醉时间、创伤程度、术后恢复时间、住院时间及肿瘤控制效果等方面效果满意,具有一定优势,是安全、有效的治疗方案,值得临床推广应用。Objective:To investigate the safety and efficacy of transabdominal laparoscopic radical nephroureterectomy with a single posture in the treatment of high-risk upper tract urothelial carcinoma(UTUC).Methods:This study included 66 patients with UTUC who underwent transabdominal laparoscopic radical nephroureterectomy in a single posture from Aug.2019 to Dec.2022.All p atients underwent prophylactic bladder perfusion(pirarubicin,30 mg,30 min)during surgery,and all surgeries were continuously performed by the same surgeon using the same surgical strategy.Perioperative indicators,pathological results,and postoperative follow-up data were collected from patients,and the surgical techniques,procedures,and operational processes were summarized.Results:All o perations were successful.There were no patients in this group who were converted to open surgery,and no complications such as he-morrhage,vascular injury,or intestinal rupture occurred during the surgery.The mean surgical time was(145.4±57.3)min,intraoperative blood loss was(126.2±37.6)mL,postoperative exhaust time was(26.4±4.2)h,postoperative eating time was(27.1±4.5)h,post-o perative ambulation time was(28.3±5.1)h,drainage tube removal time was 4.0(3.8,6.0)d,and median hospital stay was 6.0(5.0,7.0)d.The postoperative follow-up time was 16.5(11.0,25.6)months.After surgery,all patients with≥T_(2)stage underwent 3-6 c ycles GC regimen chemotherapy,and no prophylactic bladder perfusion was performed.There was no tumor recurrence or distant metastasis during the follow-up period.Conclusions:Transabdominal laparoscopic radical nephroureterectomy with a single posture has satisfactory results in terms of surgical time,anesthesia time,degree of trauma,postoperative recovery time,hospital stay,and tumor c ontrol effect.It has certain clinical advantages and is a safe and effective surgical treatment plan,which is worthy of clinical promotion and a pplication.

关 键 词：肾输尿管切除术 腹腔镜检查 经腹膜入路 一体位 

分 类 号：R699[医药卫生—泌尿科学]