完全腹腔镜下肾输尿管全长切除治疗上尿路上皮癌的疗效分析  

Analysis of the therapeutic effect of complete laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma

作　　者：雷霆[1] 谢蛟魁 王晓 邱明浩 张玉璞 邓久晗 王春杨 符伟军 LEI Ting;XIE Jiaokui;WANG Xiao;QIU Minghao;ZHANG Yupu;DENG Jiuhan;WANG Chunyang;FU Weijun(Department of Urology,Ankang Central Hospital,Shaanxi Ankang 725000,China;The First Medical Center of the General Hospital of the Chinese People's Liberation Army,Beijing 100000,China)

机构地区：[1]安康市中心医院泌尿外科,陕西安康725000 [2]中国人民解放军总医院第一医学中心,北京100000

出　　处：《现代肿瘤医学》2024年第24期4644-4648,共5页Journal of Modern Oncology

摘　　要：目的:评价完全腹腔镜下肾输尿管全长切除治疗上尿路上皮癌(upper urinary tract urothelial carcinoma,UUT-UC)的临床疗效。方法:回顾性分析本院2011年01月至2023年10月及中国人民解放军总医院第一医学中心2016年08月至2020年02月诊治的UUT-UC患者共64例的临床病例资料,再根据不同腹腔镜手术方式的选择分成两组:患者经尿道电切膀胱袖状切除+后腹腔镜下肾输尿管全长切除+经腹部切口取肾术,共行40例,为对照组;选择完全腹腔镜下肾输尿管全长切除+膀胱壁内段袖状切除+下腹正中切口取肾术为观察组,共24例;比较两组手术时间、出血量、术后引流量、术后排气时间、平均住院日及尿路上皮癌的复发率。结果:观察组的手术时间明显短于对照组(平均124 min与166 min,P<0.05),出血量明显低(平均46 mL与86 mL,P<0.05),术后引流量少(平均68 mL与142 mL,P<0.05),平均住院日短(平均5.4 d与6.8 d,P<0.05);而术后排气时间及尿路上皮癌复发率两组均无统计学差异(P>0.05)。结论:经腹腔完全腹腔镜下肾输尿管全长切除术治疗UUT-UC具有手术时间短、出血量少、术后恢复快等优点,在临床上是一种安全有效的微创手术治疗方法,值得临床推广应用。Objective:To evaluate the clinical efficacy of complete laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma(UUT-UC).Methods:We retrospectively analysed the clinical case data of 64 patients with UUT-UC from January 2011 to October 2023 in our hospital and from August 2016 to February 2020 in the First Medical Center of the General Hospital of the Chinese People's Liberation Army,and then divided them into two groups according to the choice of different laparoscopic surgical modalities.Patients in control group(n=40)underwent transurethral electrodesiccation cystectomy with sleeve resection+posterior laparoscopic nephroureterectomy with full-length resection+transperitoneal laparoscopic nephroureterectomy.Patients in observation group(n=24)underwent complete laparoscopic nephroureterectomy with full-length resection+sleeve resection of the inner segment of the bladder wall+middle laparoscopic nephroureterectomy of the lower abdomen.The two groups of surgical time,bleeding volume,postoperative drainage volume,postoperative exhaust time,average hospital stay and recurrence rate of urinary tract urothelial carcinoma were compared.Results:The operation time of the observation group was significantly shorter than that of the control group(mean 124 min versus 166 min,P<0.05),the bleeding volume was significantly lower(mean 46 mL versus 86 mL,P<0.05),the postoperative drainage volume was less(mean 68 mL versus 142 mL,P<0.05),and the mean hospital stay was shorter(mean 5.4 d versus 6.8 d,P<0.05).The postoperative venting time and the recurrence rate of uroepithelial cancer were not statistically significant in both groups(P>0.05).Conclusion:Transabdominal complete laparoscopic nephroureterectomy for the treatment of UUT-UC has the advantages of short operation time,low bleeding and fast postoperative recovery,which is a safe and effective minimally invasive surgical treatment in clinic,and it is worth to be popularised and applied in clinic.

关 键 词：上尿路上皮癌 腹腔镜 肾输尿管全长切除术 

分 类 号：R737.11[医药卫生—肿瘤]