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。

Study for tumor free principle in retroperitoneal iaparoscopic nephroureterectomy for upper urinary urothelial carcinoma

Objective To evaluate the feasibility and effectiveness of transurethral electric coagulation combined with retroperitoneal laparoscopie nephroureterectomy （LNU） for upper urinary tract urothelial carcinoma （UUT-UC）. Methods From Februrary 2010 to October 2012, 168 cases with upper urinary tract urothelial carcinoma were included in the study. Of all the cases, 83 cases underwent retroperitoneal LNUs combined with transurethral electric coagulation for UUT-UC （test group）, and 85 cases underwent retroperitoneal LNUs combined with transurethral electric resection for UUT-UC （control group）. The operation time, blood loss, postoperative hospital stay and tumor recurrence rate were compared. Results All 168 cases of operation for UUT-UC were accomplished successfully, without death or severe complication. There was no statistical difference of mean operation time, blood loss, tumor stage and tumor grade between two groups. The mean postoperative hospital stay of experimental group was shorter than that of control group （P〈O.05）. One year recurrence rate of TCC of experimental group was lower than that of control group （1.6% vs 13.1%, P〈0.05）. Conclusions Retroperitoneal LNU for UUT-UC combined with transurethral electric coagulation offers advantage of shorter hospital stay, less tumor cell implantation, and lower tumor recurrence rate,abide by non-tumor principle in of upper urinary urothelial Carcinoma at great extent, and can be applicated generally.