开放手术与后腹腔镜手术治疗器官局限性上尿路上皮癌的疗效比较

目的:比较开放手术与后腹腔镜手术治疗器官局限性上尿路上皮癌的疗效。方法:回顾性分析我院2010年01月至2015年12月75例接受手术治疗器官局限性上尿路上皮癌患者的临床资料，其中34例行开放肾输尿管加膀胱部分切除术（ONU组）治疗，41例行后腹腔镜肾输尿管加膀胱部分切除术（LNU组）治疗,比较两组患者的基线临床资料、围术期资料及随访预后结果。结果:ONU组的手术时间短于LNU组［136.0（111.0~180.0） min vs 180.0（130.0~210.0）min,Z= 2.525,P=0.012］。LNU组的出血量少于ONU组［100（100~200） mL vs 200（100~300） mL,Z= 2.197,P=0.028］。两组患者术后排气时间、引流管去除时间、术后住院时间及术后并发症发生率差异无明显统计学意义（P＞0.05）。ONU组中位随访时间42.5个月，LNU组中位随访时间41.0个月，总生存率（P=0.817）、肿瘤特异性生存率（P=0.448）、无复发进展率（P=0.789）、膀胱内无复发率（P=0.138）在两组患者中差异无明显统计学意义。结论:开放手术与后腹腔镜镜手术均是治疗器官局限性尿路上皮癌的有效方法，应根据临床具体情况选择手术方式。

A comparison of open and retroperitoneal laparoscopic surgery for the treatment of organ-confined upper urinary tract urothelial carcinoma

Objective:To compare of the effect of open and retroperitoneal laparoscopic surgery for the treatment of organ-confined upper urinary tract urothlial carcinoma(UTUC).Methods:We retrospectively studied 75 UTUC patients who underwent radical nephroureterectomy at our center between January,2010 and December,2015.Thirty-four patients treated with open radical nephroureterectomy(ONU group) with the excision of the bladder cutoff.Forty-one patients treated with retroperitoneal laparoscopic nephroureterectomy(LNU group) with the excision of the bladder cuff.Patient clinicopathological data and perioperative and prognostic data were recorded and evaluated.Results:In the ONU group,the time of surgery was shorter than LNU group ［136.0(111.0~180.0) min vs 180.0(130.0~210.0) min,Z= 2.525,P=0.012］.The estimated blood loss in the LNU group was lower than ONU group ［100(100~200) mL vs 200(100~300) mL,Z= 2.197,P=0.028］.The bowel recovery time,the time to drain removal,duration of hospital stay,the complications were not different significantly(P＞0.05) in two groups.The overall survival(OS)(P=0.817),the cancer-specific survival(CSS)(P=0.448),the recurrence-free survival(RFS)(P=0.789),the intravesical recurrence-free survival(IVRFS)(P=0.138) were equivalent in two groups with a median follow-up period of 42.5 months and 41.0 months.Conclusion:The open and retroperitoneal laparoscopic surgery are effective and feasible,we should choose different surgery methods according to particular cases.