后腹腔镜联合膀胱电切镜对上尿路移行细胞癌根治性治疗的安全性研究

目的探讨后腹腔镜联合膀胱电切镜对肾盂、中上段输尿管移行细胞癌根治性治疗的手术及肿瘤学安全性。方法回顾性分析肾盂、中上段输尿管移行细胞癌患者58例临床资料，后腹腔镜联合膀胱电切镜肾输尿管全长切除组（A组）41例，开放肾输尿管切除组（B组）17例。对其手术效果、并发症及术后肿瘤复发情况进行对比。结果A组和B组手术出血量（98．4和165mL）、术后住院天数（7．1和8．0d）、术后应用止痛药时间（1．2和3．1d）比较，A组优于B组（P〈0．05）；两组手术时间（150和110min）、术后留置尿管时间（6．2和3．5d）比较，A组长于B组（P〈0．05）。A组1例因电切输尿管口出血，中转开放手术。A、B两组并发症发生率（7．3％和11．8％）及肿瘤复发率（14．6％，23．5％）差异均无统计学意义（P均〉O．05）。结论联合尿道电切镜、后腹腔镜肾输尿管切除术与开放手术相比，出血少、术后恢复快、并发症少，未增加术后肿瘤的复发。

The safety study of retroperitoneoscopic nephroureterectomy and cystoscopic electrocision for upper tract transitional cell carcinoma

Objective To compare clinical safety and the long-term oncologic efficacy of cystoscopic excision of the ureter orifice and retroperitoneoscopic nephroureterectomy with that of open surgical nephroureterectomy in patients with upper tract transitional cell carcinoma （TCC）. Methods Retroperitoneal laparoscopic nephroureterectomy （LNU） was performed in 41 cases and open surgical nephroureterectomy （ONU） in 17 cases. The therapeutic effectiveness, complications, oncologic efficacy were compared between LNU and ONU. Results The analysis showed that the intraoperative bleeding volume, hospital stay, length of analgesic usage with LNU were significantly superior to those in ONU （P〈0.05）; while catheter preserving in ONU was less than that with LNU （P 〈 0.05）. One case with LNU converted to an open surgical procedure because of bleeding in the process of cystoscopic excision of the distal ureter orifice. The rates of complication and tumor recurrence in LNU and ONU groups were 7.3% vs. 11.8% and 14.6% vs. 23.5% respectively, and the differences were not significant. Conclusion Compared with open surgical nephroureterectomy, transurethral incision of the ureteral orifice and retroperitoneoscopic nephroureterectomy has the advantages of minimal invasion, less suffering, quicker recovery and less recurrence of neoplasms.