经腹膜后与经腹腹腔镜对治疗上尿路尿路上皮癌的临床应用分析

  目的  探讨经腹膜后与经腹行腹腔镜下肾输尿管全切除术治疗上尿路尿路上皮癌的安全性及有效性。  方法  回顾性分析2012年1月至2016年12月85例四川大学华西医院采用经腹膜后与经腹行腹腔镜下肾输尿管全切除术治疗上尿路尿路上皮癌患者的临床资料，分为A组49例、B组36例。比较两组手术时间、术中出血量、伤口引流时间、尿管留置时间、术后肠功能恢复时间、术后住院时间、术后并发症、局部复发、远处转移等指标。  结果  85例患者均顺利完成手术。A组的手术时间为（126.9±11.6）min、B组为（109.9±14.7）min，A组的术中出血量为（108.5±24.1）mL、B组为（95.1±19.9）mL，A组的术后肠功能恢复时间为（1.8±0.5）d、B组为（2.3±0.4）d，A、B两组比较差异均具有统计学意义（均P <0.05）。其余指标的两组比较差异均无统计学意义。  结论  经腹膜后与经腹行腹腔镜下肾输尿管全切除术均为治疗上尿路尿路上皮癌安全有效的微创治疗。 

Clinical analysis of retroperitoneal and transperitoneal laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma

  Objective  To evaluate the clinical effects of retroperitoneal and transperitoneal laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma.  Methods  We trospectively analyzed the clinical data of 85 patients with upper urinary tract urothelial carcinoma (UTUC) who underwent laparoscopic radical nephroureterectomy in West China Hospital, Sichuan University, from January 2012 to December 2016. Forty-nine patients (Group A) underwent retroperitoneal laparoscopic radical nephroureterectomy while 36 (Group B) underwent transperitoneal laparoscopic radical nephroureterectomy. Operative time, blood loss volume, time of incision drainage, catheterization time, recovery time of postoperative intestinal function, postoperative hospitalization time, operative complications, postoperative local recurrence, and distant metastasis were compared between the two groups.  Results  All operations were successfully performed. Mean operative time was (126.9±11.6) min in Group A, while it was (109.9±14.7) min in Group B; thus, mean operative time was significantly shorter in Group B than in Group A (P <0.05). Mean blood loss volume was (108.5±24.1) mL in Group A, while it was (95.1±19.9) mL in Group B; thus, mean blood loss volume was significantly lower in Group B than in Group A (P <0.05). Mean recovery time of postoperative intestinal function was (1.8±0.5) days in Group A, while it was (2.3± 0.4) days in Group B; thus, mean recovery time of postoperative intestinal function was significantly longer in Group B than in Group A (P <0.05). The other evaluated indicators did not differ significantly between the two groups.  Conclusions  Both retroperitoneal and transperitoneal laparoscopic radical nephroureterectomy are safe and effective as minimally invasive treatment for upper UTUC.