改良后腹腔镜手术方式在上尿路肿瘤治疗的可行性和安全性*

Feasibility and safety of modified retroperitoneal laparoscopic surgery in the treatment of upper urinary tract urothelial carcinoma*

摘要:

探讨改良后腹腔镜手术方式在上尿路肿瘤治疗的可行性及安全性。方法 回顾性分析该院40例腹腔镜手术治疗肾盂癌及中上段上尿路肿瘤患者病例，其中21例患者选择改良后腹腔镜联合经尿道电切镜下肾、输尿管切除术（A组），另外19例患者采用后腹腔镜联合下腹部小切口、经尿道电切镜肾、输尿管切除术（B组）。比较两种手术方式的手术时间、术中出血量、术后留置引流管时间、术后首次肛门排气时间及术后住院时间的差异。结果 两组共40名患者，手术均顺利完成，无中转手术。A组与B组患者平均年龄、性别比、肿瘤位置比较，差异无统计学意义（P >0.05）。A组手术时间较B组明显缩短（P <0.01）；A组患者术后住院时间明显少于B组（P <0.05）。两组均无术中、术后并发症。A、B组间术中失血量、术后留置引流管时间、术后首次肛门排气时间均差异无统计学意义（P >0.05）。结论 和后腹腔镜联合下腹部小切口手术方式相比，改良后腹腔镜手术方式安全有效，可缩短手术时间，减少患者术后住院时间，可在上尿路肿瘤，特别是肾盂及中上段输尿管肿瘤的治疗中选择应用。

Abstract:

Abstract: Objective To evaluate the application of two kinds of retroperitoneal laparoscopic nephroureterectomy in upper urinary tract urothelial carcinoma and select the best operative approaches. Methods The clinical data of 40 cases of retroperitoneal laparoscopic surgery in patients with upper urinary tract tumor were analyzed. Among the 40 patients, 21 cases (14 males and 7 females) underwent modified retroperitoneal laparoscopic nephroureterectomy combined with transurethral incision of the ureteral orifice (group A), and 19 cases (13 males and 6 females) underwent retroperitoneal laparoscopic nephroureterectomy combined with hypogastrium minor incision and transurethral incision of the ureteral orifice (group B). The operative time, the blood loss, the retention time of drainage tube, the first exhaust time of postoperative and the hospital stay were compared between the two groups. Results The operation was successfully completed in all the 40 cases without conversion to open surgery. The operative time in group A was significantly shorter than that in group B (P < 0.01), and the hospital stay was significantly shorter than that in group B (P < 0.05). There were no statistical differences in blood loss, the retention time of drainage tube, and the first exhaust time of postoperative between the two groups (P > 0.05). Conclusions Compared with the retroperitoneal laparoscopic nephroureterectomy combined with hypogastrium minor incision, the modified retroperitoneal laparoscopic nephroureterectomy is safe and effective, which can shorten the operative time and reduce hospital saty. Tumor located in renal pelvis and the proximal & middle part of ureter, modified retroperitoneal laparoscopic nephroureterectomy combined with transurethral incision of the ureteral orifice is the most effective method.