改良经腹入路全腹腔镜下上尿路 上皮癌根治术的临床研究

Clinical study of modified transabdominal laparoscopic radical operation for upper urinary tract epithelial cancer

摘要:

摘要：目的??评价改良的经腹入路腹腔镜下上尿路上皮癌根治术的手术技巧及临床效果。方法 对郑州大学附属洛阳中心医院2013年9月－2018年4月收治的104例上尿路上皮癌患者随机分为两组。51例侧卧位行经腹入路腹腔镜下切肾后，改平卧位下腹部切口处理输尿管膀胱连接部并取出标本（标准组）；53例行改良经腹入路全腹腔镜下上尿路上皮癌根治术（改良组）。比较两组患者的手术时间、术中出血量、术后疼痛程度、住院时间，术后引流量和术后短期并发症发生率等临床指标。术后疼痛程度评估采用疼痛数字评定量表（NRS）。结果?改良组手术时间及住院时间明显少于标准组，差异均有统计学意义（P <0.05），改良组术后疼痛程度较标准组轻，术后引流量少，差异均有统计学意义（P <0.05）。改良组术中出血量虽较标准组少，但两组比较，差异无统计学意义（P >0.05）。标准组术后出现短期并发症11例（21.6%），改良组4例（7.5%），改良组明显少于标准组（P <0.05）。结论 改良经腹入路全腹腔镜下上尿路上皮癌根治术是一种安全有效的手术方法，值得临床推广。

Abstract:

Abstract: Objective?To evaluate the surgical technique and clinical effect of modified transabdominal laparoscopic radical operation for upper urinary tract epithelial cancer.?Methods?104 patients with upper urinary tract epithelial cancer from September 2013 to April 2018 were randomly divided into two groups. 51 cases of lateral decubitus position underwent laparoscopic nephrectomy via abdominal approach and then changed to supine position through lower abdominal incision to treat ureterovesical junction and take out specimens (standard group). 53 cases underwent modified transabdominal laparoscopic radical operation for upper urinary tract epithelial cancer (modified group). The operation time, intraoperative blood loss, postoperative pain, hospitalization time, postoperative drainage volume and short-term complication rate were compared between the two groups. Postoperative pain degree was assessed by pain numeric rating scale.?Results?The operation time and hospitalization time of the improved group were shorter than those of the standard group, the difference was statistically significant (P < 0.05). The pain degree of improved group was lighter than standard group after the operation, and the drainage volume was less than standard group after the operation. The difference was statistically significant (P < 0.05). Although the intraoperative blood loss in improved group was less than standard group, there was no significant difference between the two groups (P > 0.05). There were 11 patients with short-term complications in the standard group (21.6%) and 4 patients with short-term complications in the improved group (7.5%), The incidence of short-term complications in improved group was significantly less than conventional group (P < 0.05).?Conclusion?The modified transabdominal laparoscopic radical operation for upper urinary tract epithelial cancer is a safe and effective method, which is worthy of clinical promotion.