后腹腔镜下行上尿路上皮癌根治术2种输尿管末端处理方式的疗效比较

目的探讨经后腹腔途径借助完全腹腔镜下肾输尿管切除及膀胱袖状切除术的安全性、有效性及可行性。方法回顾性收集2016年10月至2018年10月于山西医科大学第一医院泌尿外科确诊为上尿路尿路上皮癌(UUT-UC)的60例患者的资料,根据治疗术式的不同分为完全后腹腔镜组、联合下腹小切口组,其中完全后腹腔镜组29例患者行完全后腹腔镜下肾输尿管切除及膀胱袖状切除术,联合下腹小切口组31例患者行后腹腔下肾输尿管切除联合下腹部小切口膀胱袖状切除术。记录两组的手术时间、术中出血量及术后恢复情况。结果完全后腹腔镜组平均手术时间(143±12)min,联合下腹小切口组平均手术时间(206±19)min,两组平均手术时间差异有统计学意义(P<0.05);两组的术中出血、排气时间、VAS评分、住院时间和肿瘤复发转移差异无统计学意义(P>0.05)。结论在处理输尿管末端时,完全后腹腔镜下肾输尿管切除及膀胱袖状切除术的手术时间短,手术过程安全、疗效确切,值得在临床上进一步推广。

A comparative study of two treatment methods in radical retroperitoneal laparoscopic nephroureterectomy of upper urinary tract urothelial carcinoma

Objective To investigate the safety,effectiveness and feasibility of radical retroperitoneal laparoscopic nephroureterectomy and bladder sleeve resection in the treatment of upper urinary tract urothelial carcinoma(UUT-UC).Methods The clinical data of 60 UUT-UC cases treated in our hospital during Oct.2016 and Oct.2018 were retrospectively collected.The patients were divided into two groups:radical retroperitoneal laparoscopic group(n=29)was treated with radical retroperitoneal laparoscopic nephroureterectomy plus bladder sleeve resection,while lower abdominal small incision group(n=31)was treated with radical retroperitoneal laparoscopic nephroureterectomy plus open-surgery bladder sleeve resection.The operation time,hemorrhage volume and postoperative recovery of the two groups were compared and analyzed.Results The average operation time of radical retroperitoneal laparoscopic group(143±12)min]and lower abdominal small incision group(206±19)min]were significantly different(P<0.05),while there were no significant differences in hemorrhage volume,evacuation time,VAS score,hospital stay,recurrence and metastasis between the two groups(P>0.05).Conclusion In the treatment of upper urinary tract urothelial cancer,radical retroperitoneal laparoscopic nephroureterectomy plus bladder sleeve resection is safe and effective,and needs short operation time.It is worth of clinical promotion.