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。

Comparative evaluation between retroperitoneoscopic nephroureterectomy plus regional lymph node dissection and open surgery for upper urinary tract transitional cell cancinoma

Objective： To explore the operative effects of two kinds of surgical methods, laparoscopic radical nephroureterectomy and open ureteral resection. Method： We retrospectively analyzed the operating time, blood loss, postoperative recovery, oncologic outcomes of laparoscopic radical nephroureterectomy （23 cases） and open ureteral resection （14 cases）. The therapeutic effects and postoperative recovery were compared between laparo- scopic group and open group. Result：The results of pathological examination showed that 24 cases were found renal pelvic carcinoma, ten patients were found ureteral cancer, and three cases were found ureteral cancer combined with bladder cancer in laparoscopic group. Lymphatic metastasis could be seen in one patient of both two groups. The postoperative data of laparoscopic group showed that the intra-operative blood loss was （94.35± 10.15） ml, the postoperative intestinal function recovery time was （1. 117±0. 1236） day, and hospital stay was （7. 087±0. 3074） day. All these data and prognosis of laparoscopic group proved to be significantly superior to those with open group （P〈0.05）. Conclusion： Compared with open ureteral resection, laparoscopic radical nephroureterecto- my plus retroperitoneal lymph node dissection has the advantage of minimal invasion, less injury, quick recovery and better prognosis.