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
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摘要
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方法。
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.
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.
引文
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[10]李鹏超,周海,李普,等.上尿路尿路上皮癌行后腹腔镜下肾输尿管切除术103例临床分析[J].微创泌尿外科杂志,2012,1(1):67-69.
[11]陈放,熊玮,杜杨春,等.腹部小切口联合后腹腔镜术治疗肾盂癌的临床观察及预后影响因素分析[J].解放军医药杂志,2017,29(3):35-38.
[12]张瑞明,曹宇,吴学良,等.经腹腔途径腹腔镜下肾盂癌根治术临床体会[J].中国内镜杂志,2015,21(6):666-667.
[13]夏利刚,甘亚波.完全腹腔镜下肾、输尿管及膀胱袖状切除术对上尿路肿瘤的应用观察[J].世界最新医学信息文摘,2018,18(71):165-166.
[2]张树雨,金铁雄.腹膜后腹腔镜肾盂癌根治术38例临床分析[J].吉林医药学院学报,2016,37(1):28-30.
[3]Wang N,Wang K,Zhong D,et al.Port-site metastasis as a primary complication following retroperitoneal laparoscopic radical resection of renal pelvis carcinoma or nephron-sparing surgery:A report of three cases and review of the literature[J].Oncol Lett,2016,11(6):3933-3938.
[4]林榕城,周朝晖,钟文龙,等.完全腹膜后镜肾输尿管全长切除术治疗上尿路尿路上皮癌的临床分析[J].现代泌尿外科杂志,2018,23(10):748-751.
[5]刘安伟,许传亮.腹腔镜下输尿管癌根治性切除术与开放手术的对比[J].中国继续医学教育,2016,8(19):134-135.
[6]徐林峰,甘卫东,张士伟,等.经尿道电切镜辅助后腹腔镜治疗上尿路尿路上皮癌:附视频[J].中华腔镜泌尿外科杂志,2015,9(1):26-29.
[7]姚俊波,夏涛,程汉波,等.经尿道钬激光联合后腹腔镜在肾盂癌治疗中的应用[J].实用癌症杂志,2013,28(6):728-730.
[8]Arango O,Bielsa O,Carles J,et al.Massive tumor implantation in the endoscopic resected area in modified nephroureterectomy[J].J Urol,1997,157(5):1839-1842.
[9]Ito A,Shintaku I,Satoh M,et al.Prospective randomized phase II trial of a single early intravesical instillation of pirarubicin(THP)in the prevention of badder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma:the THP monotherapy study group trial[J].J Clin Oncol,2013,31(11):1422-1427.
[10]李鹏超,周海,李普,等.上尿路尿路上皮癌行后腹腔镜下肾输尿管切除术103例临床分析[J].微创泌尿外科杂志,2012,1(1):67-69.
[11]陈放,熊玮,杜杨春,等.腹部小切口联合后腹腔镜术治疗肾盂癌的临床观察及预后影响因素分析[J].解放军医药杂志,2017,29(3):35-38.
[12]张瑞明,曹宇,吴学良,等.经腹腔途径腹腔镜下肾盂癌根治术临床体会[J].中国内镜杂志,2015,21(6):666-667.
[13]夏利刚,甘亚波.完全腹腔镜下肾、输尿管及膀胱袖状切除术对上尿路肿瘤的应用观察[J].世界最新医学信息文摘,2018,18(71):165-166.