经腹腹腔镜与后腹腔镜治疗上尿路尿路上皮癌的比较研究

目的探讨完全腹腔镜下肾输尿管全长切除、膀胱袖状切除术治疗上尿路尿路上皮癌的有效性和安全性。方法回顾性分析2010年10月~2015年10月上尿路尿路上皮癌79例资料,其中经腹完全腹腔镜下肾输尿管全长切除及膀胱袖状切除术47例(CTLNU组),后腹腔镜肾输尿管全长切除+下腹部小切口膀胱袖状切除术32例(RLNU组)。记录手术时间、术中出血量、术后肛门排气时间和术后住院时间。结果与RLNU组相比,CTLNU组手术时间短[(120.5±21.6)min vs.(145.2±29.9)min,t=-4.265,P=0.000],术中出血量少[(120.8±42.4)ml vs.(190.6±60.8)ml,t=-6.017,P=0.000],术后住院时间短[(8.2±2.5)d vs.(9.9±3.2)d,t=-2.646,P=0.010];术后肛门排气时间差异无统计学意义(P0.05)。CTLNU组和RLNU组随访发现膀胱尿路上皮癌分别为5例和3例(P0.05),行经尿道膀胱肿瘤电切术治愈,远处转移分别为2例和3例(P0.05)。结论完全腹腔镜下肾输尿管全长切除、膀胱袖状切除术是治疗上尿路尿路上皮癌的可行、安全、有效的微创方法。     

腹腔镜治疗上尿路移行细胞癌的手术路径选择

目的 探讨腹腔镜治疗上尿路移行细胞癌不同的手术路径选择.方法 将116例上尿路移行细胞癌患者分为A、B两组,A组为肾孟及输尿管上段肿瘤组,采用后腹腔镜联合经尿道电切的方法;B组为输尿管下段肿瘤组,6例输尿管局部浸润的患者列入本组,采用70°斜侧卧位经腹腔途径肾、输尿管切除并膀胱袖状切除.结果 116例手术均获成功,无术中并发症.A组手术时间平均125.5 min,术中出血平均60 ml,术后24～48 h胃肠功能恢复;术后住院时间平均7 d;B组手术时间平均140.6 min,术中出血平均96 ml,术后24～72 h胃肠功能恢复;术后住院时间平均7.5 d.有90例患者获得随访,平均随访时间27个月,未发现切口及穿刺孔种植转移,但有10例行膀胱镜检查发现膀胱肿瘤.结论 腹腔镜肾、输尿管全切和膀胱袖状切除治疗上尿路移行细胞癌符合肿瘤治疗原则,安全可行.应根据肿瘤的位置来决定手术方式的采用.     

经腹入路一站式腹腔镜肾脏-输尿管-膀胱袖状切除术治疗上尿路尿路上皮癌的临床研究

目的:探讨完全腹腔镜下经腹入路一站式肾脏-输尿管-膀胱袖状切除术治疗上尿路尿路上皮癌(UTUC)的手术技巧和临床效果。方法:2015年2月～2018年5月我院通过影像学检查或输尿管镜活检确诊的17例UTUC患者行完全腹腔镜下经腹入路一站式肾脏-输尿管-膀胱袖状切除手术。采取健侧60°卧位,放置5个Trocar,先行患侧根治性肾切除,然后沿输尿管向下游离至输尿管膀胱入口处,再将输尿管开口周围膀胱壁作袖状切除,缝闭膀胱切口。结果:17例手术均获成功,无中转开放,手术时间110～150min,平均125min;术中出血80～200ml,平均120ml;术后住院6～14d,平均8d;术后漏尿1例,引流后自愈。术后随访6～45个月,其中术后漏尿患者于术后9个月发现对侧输尿管口周围尿路上皮癌复发,行经尿道膀胱肿瘤电切术(TURBt),随访至今未见复发;失访3例,其余病例未见术中术后并发症,未见肿瘤复发及转移。结论:经腹入路一站式腹腔镜肾脏-输尿管-膀胱袖状切除术治疗UTUC安全可行,术中无需变换体位就能完成从肾脏到输尿管全段和膀胱袖状切除,是一种值得推广的手术方法。     

机器人辅助腹腔镜“一步法”半尿路切除术(“大家泌尿网”观看手术视频)

根治性肾输尿管全长及膀胱袖套状切除术是上尿路尿路上皮癌的标准治疗方案,传统开放手术创伤较大、切口长、术后恢复时间长,腹腔镜肾切除术后采用下腹部切口取出标本并行膀胱袖状切除虽减少了手术创伤,但术中仍需要变换体位重新消毒,延长了手术时间。目前机器人辅助腹腔镜下根治性肾输尿管全长及膀胱袖状切除手术进一步提高了手术的精准度,我们采用单一体位一次性装机完成上尿路肿瘤的根治手术。本文就机器人辅助腹腔镜“一步法”半尿路切除术的手术步骤及技术要点等进行介绍。     

腹腔镜肾输尿管全长切除术及膀胱袖状切除术治疗上尿路移行细胞癌

目的:评价腹腔镜经腹腔径路行肾输尿管全长切除术及膀胱袖状切除术治疗上尿路移行细胞癌的有效性及安全性。方法:对6例上尿路移行细胞癌患者行腹腔镜经腹腔径路肾切除术,经同侧下腹斜切口、袖状切除输尿管并完整取出标本。结果:6例手术均获成功,无中转开放手术,手术时间200～320min,平均250min,术中出血100～300ml,均未输血,住院8～12d,平均9d,术后常规膀胱灌注丝裂霉素,随访2～14个月,均无复发或转移。结论:腹腔镜肾输尿管全长切除术是治疗上尿路移行细胞癌安全有效的微创手术,具有痛苦小、康复快等优点。     

经腹腔路径完全腹腔镜下移植肾同侧原肾输尿管全长切除术2例报告（附视频）

目的探讨经腹腔路径完全腹腔镜下移植肾同侧原肾输尿管全长切除术治疗肾移植受者上尿路移行细胞癌的技术要点及临床效果。方法 2例肾移植术后移植肾同侧上尿路移行细胞癌患者,采用经腹腔路径完全腹腔镜下操作方法切除移植肾同侧原肾及输尿管全长。通过腹腔镜切除的原肾及输尿管最终从下腹正中小切口完整取出。结果两例手术时间分别为180,120 min,术中出血量分别为80,20 mL;无术中、术后并发症,术后血红蛋白及血清肌酐无明显变化。术后随访6个月均未出现肿瘤复发及转移。结论经腹腔路径完全腹腔镜下肾输尿管全长切除术治疗肾移植后移植肾同侧上尿路移行细胞癌具有手术损伤小、患者痛苦少、术后恢复快等优点,是一种安全有效的微创治疗方法。     

经腹腔入路完全腹腔镜根治性肾输尿管切除及膀胱袖状切除术治疗上尿路尿路上皮肿瘤的临床研究

目的探讨经腹腔入路完全腹腔镜根治性肾输尿管及膀胱袖状切除术治疗上尿路尿路上皮肿瘤的安全性和可行性。方法回顾性分析2009年1月至2014年12月本中心收治的49例行根治性肾输尿管及膀胱袖状切除术的上尿路尿路上皮肿瘤患者的临床资料。其中28例(57.14%)行经腹腔入路完全腹腔镜肾输尿管切除及膀胱袖状切除术(A组),21例(42.86%)行经腹腔入路腹腔镜肾输尿管切除联合开放输尿管远端及膀胱袖状切除术(B组)。本研究从手术时间、失血量、术后住院时间、肿瘤病理分期及分级、肿瘤复发率进行两组间比较。结果两组共49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、体重指数(BMI)、首诊原因、肿瘤位置比较,差异无统计学意义。A组手术时间[(112.9±33.8)分钟]较B组[(170.0±50.3)分钟]明显缩短(P0.001);A组术中出血量[(72.9±35.2)ml]明显少于B组[(120.5±71.1)ml](P=0.009)。两组均无术中并发症,A组无术后并发症,但B组术后出现1例下腹切口脂肪液化。A组患者术后住院时间[(11.0±2.8)天]明显少于B组[(16.1±6.0)天](P0.001)。手术标本切缘均为阴性。两组之间病理分级分期分布无统计学差异。A、B两组的中位随访时间分别为24个月及29.5个月。两组间尿路上皮无肿瘤复发生存率、肿瘤无转移生存率、肿瘤特异性生存率无显著差异(Log-rank检验;UTFS:P=0.47;MFS:P=0.53;CSS:P=0.90)。结论经腹腔入路完全腹腔镜根治性肾输尿管切除及膀胱袖状切除术是一种安全、有效的改良方法。术中无需变更患者体位、手术失血量少、手术时间较短及术后住院康复速度快是其主要优势。但今后还需要进行长期的随访以获得更有参考价值的肿瘤学结果。     

经腹腔与经后腹腔途径行腹腔镜上尿路尿路上皮癌根治性切除术的疗效比较

目的:探讨经腹腔途径行腹腔镜上尿路尿路上皮癌根治术的安全行、可行性及优势。方法:收集2012年10月~2014年11月收治的上尿路尿路上皮癌患者29例,随机分成两组,A组14例,采用后腹腔途径行腹腔镜上尿路尿路上皮癌根治性切除术;B组15例,行不改变患者体位的经腹腔途径行完全腹腔镜肾输尿管及膀胱袖状切除术。观察两组的手术时间及患者术后恢复情况。结果:A组手术时间(198±20)min,B组手术时间(145±24)min,两组手术时间差异有统计学意义(P0.05);术中出血、术后康复时间、随访时间及肿瘤复发情况,两组差异无统计学意义(P0.05)。结论:不改变患者体位的经腹腔途径更节省手术时间,其完全腹腔镜肾输尿管及膀胱袖状切除治疗上尿路尿路上皮癌是安全可行的。     

腹腔镜手术治疗上尿路移行细胞癌不同路径的选择和应用

目的 比较腹腔镜下手术治疗上尿路移行细胞癌的不同路径、输尿管处理方法及其适应证. 方法 94例上尿路移行细胞癌患者,均行肾、输尿管切除并膀胱袖状切除.分2组:①A组63例,为肾盂及输尿管上段肿瘤患者,采用后腹腔镜联合经尿道电切法;②B组31例,为输尿管中下段肿瘤患者及6例输尿管局部浸润患者,采用70°斜卧位经腹腔途径.观察2组手术时间、术中出血量,术后肠道功能恢复时间及术后并发症等. 结果 94例手术均成功,无术中并发症.2组平均手术时间分别为156和161 min,平均术中出血量分别为80和86 ml,术后胃肠功能恢复时间分别为24～48和24~72 h,术后平均住院时间分别为8.0和8.5 d.A组发生尿外渗2例,放置腹膜后引流管7 d愈合;形成尿囊肿1例,B超引导下穿刺引流治愈.84例获随访,平均随访23个月.2组分别有3例和5例膀胱镜检查发现膀胱肿瘤,2组均无切口及穿刺孔种植转移. 结论 腹腔镜下肾、输尿管全切和膀胱袖状切除治疗上尿路移行细胞癌安全可行,应根据肿瘤位置和是否发生局部浸润来选择手术方式.     

后腹腔镜肾输尿管全长与膀胱袖状切除术的三种术式比较（附110例报告）

目的：探讨后腹腔镜肾输尿管全长与膀胱袖状切除的最佳手术方式.方法：对110例肾盂或输尿管癌伴膀胱癌患者采用三种不同术式行肾输尿管全长及膀胱袖状切除术：A术式即后腹腔镜肾输尿管全长切除＋下腹部切口膀胱壁内段袖状切除术,共行32例 B术式即后腹腔镜肾输尿管全长切除＋经尿道电切膀胱袖状切除＋经腹部切口取肾术,共行19例 C术式即经尿道电切膀胱袖状切除＋后腹腔镜肾输尿管全长切除＋经腹部切口取肾术,共行59例.结果：手术经过均顺利.三种术式的手术时间、术中出血量、平均住院时间差异无统计学意义.围手术期死亡3例.出院后获定期随访58例,随访8～85个月,平均38.3个月,46例失访.因肿瘤转移死亡4例,因气胸、脑血管病死亡各1例.三种术式术后早期并发症、对侧病变、膀胱痛复发情况差异无统计学意义 但C术式术后死亡及转移例数较少.结论：肾盂或输尿管癌伴膀胱癌者可优先选择经尿道电切膀胱袖状切除＋后腹腔镜肾输尿管全长切除＋经腹部切口取肾术,而仅有肾盂或输尿管癌者可考虑行后腹腔镜肾输尿管全长切除＋下腹部切口膀胱壁内段袖状切除术.     

根治性肾输尿管切除术的两种术式疗效比较

目的探讨微创手术治疗肾盂输尿管癌的方法。 方法回顾性分析2017年9月至2021年10月在汉中市中心医院接受两种不同手术方式治疗肾盂及输尿管癌的病例共60例,其中经腹腹腔镜一体位肾输尿管全长切除联合使用定制的哈巴狗钳行膀胱袖状切除术30例（改良组）,后腹腔镜结合下腹部斜切口行根治性肾输尿管切除术30例(传统组)。比较两组患者围手术期资料及随访结果。 结果两组中所有患者都顺利完成手术,改良组手术时间、术中出血量、术后引流量、术后引流管保留时间和术后住院时间均少于传统组,差异具有统计学意义（P<0.05）。两组术后下床活动时间、肠功能恢复时间、术后膀胱肿瘤复发和随访时间比较,差异无统计学意义（P>0.05）。所有患者均随访1~48个月,膀胱肿瘤复发共8例,其中改良组2例,传统组6例,行经尿道膀胱肿瘤电切术治愈,其余均无瘤生存。 结论完全经腹腹腔镜一体位肾输尿管全长切除联合使用定制的哈巴狗钳行膀胱袖状切除术更加符合肿瘤根治原则,是一种安全、微创、可行、有效的方法,适合临床推广。     

不同肾盂癌根治术式的疗效观察

目的比较后腹腔镜根治性肾切除联合经尿道电切及联合下腹部小切口治疗肾盂癌的手术方法及效果。方法回顾性分析11例后腹腔镜肾输尿管全切联合经尿道膀胱输尿管袖套状切除(电切组)及15例联合下腹部小切口(切口组)进行肾盂癌根治术患者的临床资料,通过对手术时间、术中出血量、术后肠道恢复时间、术后住院时间、局部复发及转移等数据进行统计,对两种术式的操作步骤进行比较、总结并以同期开展的16例开放性肾盂癌根治性手术(开放组)做对照。结果电切组及切口组手术时间、出血量、肠道恢复时间、引流管拔出时间、术后住院天数比开放组均有明显优势,差异有统计学意义(P<0.05)。电切组与切口组手术时间、引流管拔除时间比较,差异有统计学意义(P<0.05)。术中出血量、术后住院天数、局部复发及转移,差异无统计学意义(P>0.05)。切口组1例,开放组2例出现术后切口感染。术后随访3³9个月,电切组1例局部复发,1例发生膀胱癌;切口组1例发生膀胱癌,1例肺转移。开放组1例局部复发,1例发生膀胱癌,1例肺转移。结论电切组较切口组手术时间短,没有增加出血量及术后复发、转移、肿瘤种植风险,但无下腹部切口,具有创伤小、恢复快、美观等优点,值得临床推广应用。     

Current Status of Robot Assisted Laparoscopic Radical Nephroureterectomy for Management of Upper Tract Urothelial Carcinoma

Upper tract urothelial carcinomas (UUT-UC) are usually aggressive tumours and require radical treatments. The standard of care for localised UUT-UC is radical nephroureterectomy (RNU). Robot-assisted laparoscopic surgeries are currently employed in various urological procedures, including RNU. We conducted a literature search on medical databases (PubMed/ MEDLINE) using free text keywords nephroureterectomy, distal ureter, bladder cuff, urothelial carcinoma and/or robotic. In this review, we aim to provide an up-to-date status on robot-assisted laparoscopic nephroureterectomy (RAL-NU) for the management of UUT-UC. The various surgical techniques and approaches for RAL-NU and retroperitoneal lymph node dissection (RPLND) will be discussed and their perioperative and early oncological outcomes reported. The feasibility and safety of RAL-NU has been demonstrated in a number of studies but intermediate and long term clinical and oncological outcomes are still lacking.     

后腹腔镜下的上尿路上皮癌根治术无瘤原则探讨

目的探讨经尿道电凝联合后腹腔镜治疗上尿路上皮癌（UUT—UC）的可行性和有效性。方法选择我院2010年2月至2012年10月进行的168例后腹腔镜下上尿路上皮癌根治术,其中实验组（83例）采用经尿道电凝联合后腹腔镜根治术（LNU）,对照组（85例）采用联合经尿道电切的后腹腔镜上尿路尿路上皮癌根治术,进行回顾分析,比较两组的手术时间、术中出血量、术后住院时间、肿瘤复发率。结果两组168例后腹腔镜上尿路上皮癌根治术均成功完成,未出现死亡或重大并发症。两组在手术时间、术中出血量、肿瘤分期和肿瘤分级方面差异均无统计学意义。实验组住院时间较对照组缩短,差异有统计学意义。两组1年肿瘤复发率分别为1．6％和13．1％,差异有明显统计学意义。结论联合经尿道电凝的腹腔镜上尿路上皮癌根治术能够减少患者住院时间,减少肿瘤细胞种植,降低肿瘤复发率,最大程度地符合上尿路上皮癌的无瘤治疗原则,值得临床推广。     

Two-micron thulium laser resection of the distal ureter and bladder cuff during nephroureterectomy for upper urinary tract urothelial carcinoma

The thulium laser (Tm-laser) technique has been used in the management of many urologic conditions. The present study aimed to evaluate the use of this technique for distal ureter and bladder cuff (DUBC) excision during nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC). Fifty-eight patients with UUT-UC who underwent radical nephroureterectomy were included in this retrospective study. DUBC was managed by open excision in 24 cases, by transurethral electrosurgery in 17 cases, and by transurethral Tm-laser in 17 cases. Perioperative measures and oncologic outcomes were compared among the three groups. Furthermore, 11 human ureteral segments were collected to measure the burst pressure and show physical pressure tolerance, and six ureteral segments were assessed histologically to investigate the sealing effect. Operative time and hospital stay were significantly longer, and intraoperative blood loss was significantly greater in the open excision group than in the electrosurgery and Tm-laser groups (P?<?0.05 for all). There were no significant differences in these parameters between the electrosurgery and Tm-laser groups. In addition, there were no significant differences in the incidences of bladder tumors and retroperitoneal recurrence of urothelial carcinoma among the three groups. The coagulation time and resection time were significantly shorter in the Tm-laser group than in the electrosurgery group. The mean burst pressure did not differ significantly between the tissues sealed by electrosurgery and by Tm-laser. Histopathological analyses showed that distal ureters were completely sealed by both electrosurgery and Tm-laser. The Tm-laser technique is superior to open excision and comparable to transurethral electrosurgery in the management of DUBC during nephroureterectomy for UUT-UC, offering an alternative treatment option for this condition.     

经尿道电凝联合后腹腔镜下肾输尿管切除术对尿路上皮癌患者近期预后影响研究

目的 探讨研究经尿道电凝联合后腹腔镜下肾输尿管切除术对尿路上皮癌患者近期预后的影响.方法 随机选取本院泌尿外科于2010年1月至2013年8月收治的尿路上皮癌患者80例,按照就诊序列号的先后顺序平均分为研究组和对照组.研究组患者采用经尿道电凝联合后腹腔镜下肾输尿管切除术方式进行治疗,对照组患者采用经尿道电切联合后腹腔镜下肾输尿管切除术方式进行治疗.对比两组各项手术指标、术后并发症情况以及术后各时期肿瘤复发率.结果 研究组的手术时间和术中出血量与对照组相比较,差异无统计学意义(P＞0.05),而前者术后住院时间和治疗费用较后者显著减少(P＜0.01);研究组术后并发症发生率(2.5％)较对照组(20.0％)显著降低(P＜0.05);研究组术后3个月、术后6个月、术后1年肿瘤复发率差异均无显著统计学意义(P＞0.05),术后2年研究组肿瘤复发率(5.0％)较对照组(25.0％)显著降低(P＜0.05).结论 采用经尿道电凝联合后腹腔镜下肾输尿管切除术对尿路上皮癌患者进行治疗效果显著,术后并发症发生率低,且预后效果好.     

Independent prognostic factors for initial intravesical recurrence after laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma

ObjectiveTo elucidate clinicopathologic independent prognostic factors for intravesical recurrence after laparoscopic nephroureterectomy for primary upper urinary tract urothelial carcinoma (UUT-UC).Methods and materialsThis study included 212 consecutive patients clinically diagnosed as localized UUT-UC and treated by retroperitoneal laparoscopic nephroureterectomy between January 2002 and October 2010, after exclusion of those with a previous or concurrent history of bladder cancer. The clinicopathologic features, risk factors, and intravesical recurrence–free survival were analyzed using the Kaplan-Meier method. Univariate and multivariate analyses by Cox proportional hazards regression model was used to identify independent risk factors for intravesical tumor recurrence.ResultsOf the patients, 64/212 (30.2%) developed subsequent intravesical recurrence during a median follow-up period of 39 months (range 7–78 months). Among them, 56/64 (87.5%) developed recurrent bladder cancer within 2 years after the surgery for UUT-UC, and the median interval between surgery and intravesical recurrence was 14 months (range 7–51 months). Multifocal tumors, renal insufficiency, and immunosuppression were determined as risk factors for intravesical recurrence by univariate analysis. However, by multivariate analyses, multifocality (hazard ratio = 2.060, P = 0.006) and immunosuppression (hazard ratio = 1.915, P = 0.037) were identified as independent predictors for the development of recurrent bladder cancer.ConclusionsThe incidence of intravesical recurrence after laparoscopic nephroureterectomy for UUT-UC is high, and most subsequent bladder cancers recur within 2 years after surgery. Tumor multifocality and immunosuppression are significant independent risk factors in developing initial intravesical recurrence after laparoscopic surgery for primary UUT-UC.     

Transurethral Electric Coagulation Combined With Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Urothelial Carcinoma

Retroperitoneal laparoscopic nephroureterectomy (LNU) combined with transurethral electric resection of ipsilateral bladder cuff is widely accepted to treat the upper urinary tract urothelial carcinoma (UUT-UC). To reduce the local recurrence rate, we improved the procedure from electric resection to electric coagulation. From May 2008 to July 2012, of all the 156 retroperitoneal LNU patients, 76 cases (test group) were performed with LNU combined with electric coagulation, and 80 cases (control group) were with electric resection. For the clinical outcomes, the hospital stay in the test group was shorter (5.2 ± 2.6 days versus 8.2 ± 3.4 days; P < 0.05), and the 1-year tumor recurrence rate was much lower (1.6% versus 13.3%, P < 0.05). There was no difference in operation time and blood loss between groups. Retroperitoneal LNU combined with electric coagulation is technically feasible and safe with lower tumor recurrence rate and shorter hospital stay.Key words: Retroperitoneal nephroureterectomy, Upper urinary tract, Urothelial carcinoma, Transurethral electric coagulationWith the rapid development of laparoscopic technique, laparoscopic nephroureterectomy (LNU) has gradually replaced the open surgery, and become a new standard for treating upper urinary tract urothelial carcinoma (UUT-UC).^1–3 The aim of LNU for UUT-UC is to reduce the operation damage and minimize the tumor metastasis and local planting. Nontumor is regarded as one of the most important principles to treat the UUT-UC.^4–5 Retroperitoneal LNU combined with transurethral electric resection of an ipsilateral bladder cuff could indeed decrease the damage,⁶ however, it may fail to decrease tumor metastasis and local recurrence rate, or even increase external bladder planting. We improved the surgical method from electric resection to electric coagulation. A retrospective analysis on 76 cases with UUT-UC who underwent retroperitoneal LNU combined with transurethral electric coagulation from February 2010 to July 2012 was summarized as below.     

后腹腔镜下肾输尿管切除加经尿道膀胱袖状切除治疗上尿路上皮癌

目的 探讨后腹腔镜下肾输尿管切除加经尿道膀胱袖状切除治疗上尿路上皮癌的临床效果.方法 上尿路上皮癌患者82例(肾盂癌69例,输尿管癌13例).男39例,女43例.平均年龄65(37～82)岁.电切镜经尿道膀胱袖状分离输尿管管口及壁内段,后腹腔镜下切除肾、输尿管.观察手术时间、术中出血量、引流管留置时间、尿管留置时间、术后住院日及术后并发症等.随访肿瘤转移与复发情况.结果 82例手术顺利.手术平均时间135(95～210)min.术中平均失血110(60～260)ml.术后引流管平均留置3(2～4)d.尿管平均留置6(5～7)d.术后平均住院7(6～9)d.74例患者获随访平均31(6～76)个月.高级别浸润性癌随访16例,复发转移3例;高级别与低级别非浸润性癌分别随访29例,膀胱内复发5例(高级别3例,低级别2例);切口部位肿瘤转移复发1例.3年随访肿瘤复发率为10.6%(5/47).结果 后腹腔镜下肾输尿管切除加经尿道膀胱袖状切除治疗上尿路上皮癌,输尿管口周围组织及输尿管壁内段切除确切,创伤小、康复快,手术安全易行,疗效可靠.     

后腹腔镜肾输尿管全切加腹膜后肾周区域淋巴结清扫与开放手术治疗UUT-TCC疗效比较

目的:探讨后腹腔镜技术与开放手术治疗上尿路移行细胞癌(upper urinary tract transitional cell carcinoma,UUT-TCC)的效果及优势。方法:回顾性分析2009年11月~2012年12月间,我院采用后腹腔镜下肾输尿管根治性切除术加腹膜后肾周区域淋巴结清扫术治疗肾盂输尿管癌患者23例(腹腔镜组),并与同期14例行传统开放性肾输尿管切除术患者(开放术组)的手术时间、出血量、肿瘤学预后等指标进行比较。结果:腹腔镜组患者经术后病理检查,肾盂癌24例,输尿管癌10例,输尿管癌伴膀胱癌3例,其中腹腔镜组和开放组淋巴结转移各1例。同时研究发现:①腹腔镜组与开放术组比较,手术时间缩短,出血量明显减少,术后肠胃功能恢复快,术后住院时间短,差异有统计学意义(P0.05);②两种术式肿瘤学预后在远处转移方面,腹腔镜组更少,差异有统计学意义(P0.05)。结论:后腹腔镜下肾输尿管全长切除加经尿道膀胱袖状切除并腹膜后肾周区域淋巴结清扫治疗UUT-TCC具有创伤小、痛苦少、术后恢复快等优点,可能有更好的肿瘤学预后。