后腹腔镜肾输尿管全切除术与开放手术治疗上尿路移行细胞癌临床疗效比较
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摘要
泌尿系肿瘤中上尿路恶性肿瘤发病率不高,约占整个尿路上皮恶性肿瘤的4%。肾盂、输尿管癌多为移行上皮细胞癌。目前临床上肾盂、输尿管癌治疗主要采取根治性手术。目前手术的方法有包括经典的肾盂输尿管癌的手术,标准的术式为患肾及输尿管的全切和输尿管开口处膀胱袖套状切除。近20年来因腹腔镜设备的不断改善和操作技术的熟练,腹腔镜技术在泌尿外科的应用越来越广泛,微创治疗肾盂输尿管肿瘤已经成为国内外泌尿科医师的共识,主要有手助腹腔镜治疗肾盂或输尿管癌、输尿管末端电切联合经腹腔途径腹腔镜肾输尿管切除术、输尿管末端电切后腹腔镜下肾输尿管及膀胱袖状切除术。我科于2004年6月以来采用新型的后腹腔镜加下腹部小切口术行肾盂、输尿管癌根治性切除术,无论术中还是术后都得到比较满意的效果,具有创伤小、出血少、并发症少、切除标本完全、恢复快、符合肿瘤根治外科学原则等优点,符合微创要求且安全有效,随着腹腔镜器械的发展和医生手术经验的积累及腹腔镜技术的改进,后腹腔镜下肾输尿管全切除术有望成为治疗上尿路移行细胞癌的新标准。
目的:比较上尿路移行细胞癌行后腹腔镜肾输尿管全切除术与开放手术的临床疗效。
方法:36例上尿路移行细胞癌患者行后腹腔镜下肾输尿管全切除术(A组),并与同期29例开放手术(B组)进行对比。对两组患者的手术时间、术中失血量、肠功能恢复时间、止痛剂使用量和住院时间等进行统计分析。并对患者随访4-36个月,比较两组的生存率、膀胱肿瘤复发情况。
结果:所有手术均成功完成,无死亡病例,A组无中转开放手术病例。平均手术时间A组(156±28)min,B组(138±19) min (P <0.05);术中出血A组(120±30) ml,B组(180±29)ml,(P <0.01);术后肠功能恢复时间A组(36.7±8.2)h,B组(37.2±7.2) h( P >0. 05);术后止痛药物使用剂量A组(38.6±15.1)mg ,B组(50.9±19.7)mg( P < 0.05),平均住院天数A组(8.7±1.3)d ,B组(9.2±1.8)d( P > 0.05)。后腹腔镜组(A组)平均手术时间略长于开放手术组(B组)(P<0.05)。后腹腔镜组平均术中出血量、平均术后止痛药物剂量均少于开放组(P<0.05);两组平均术后肠功能恢复时间、平均术后住院天数相比差别无统计学意义(P>0.05);随访4～36个月,两组膀胱复发率相比无统计学意义(P>0.05)。
结论:后腹腔镜下肾输尿管全切除术具有创伤小、出血少、并发症少、切除标本完全、恢复快、符合肿瘤根治外科学原则等优点,已经成为治疗上尿路移行细胞癌较理想的手术方法。
【Objective】To compare the clinical efficacy of retroperitoneal laparoscopy nephroureterectomy and open nephroureterectomy for treating the transitional cell carcinoma of upper urinary tract.
【Methods】Thirty-six patients with transitional cell carcinoma of upper urinary tract underwent retroperitoneal laparoscopy nephroureterectomy and other twenty-nine patients underwent open nephroureterectomy synchronization. The operation time,blood loss amount,recovery time of intestine function,dosage of painkiller and hospital days were compared and analyzed. All the cases were followed up for 4-36 months and the survival rates,bladder carcinoma recurrence were recorded.
【Results】All operations were completed successfully,no death occurred and there was no conversion to open surgery in group A. The mean operative time was (156±28)min in group A and (138±19) min in group B (P <0.05). The mean bleeding volume was (120±30) mL in group and (180±29) mL in group B (P <0.01). The recovery time of intestine function was (36.7±8.2)h in group A and (37.2±7.2) h in group B ( P >0. 05). The dosage of painkiller was (38.6±15.1)mg in group A and (50.9±19.7)mg in group B (P < 0.05).The hospital days in group A were (8.7±1.3)d and (9.2±1.8)d in group B (P > 0.05). The operation time in A group was similarly longer than that in the B group (P < 0. 05).The blood loss amount and dosage of painkiller in A group were shorter than those in B group (P < 0. 05). The recovery time of intestine function and hospital days were not significantly different in two groups(P > 0.05).The recurrence of bladder carcinoma was not significantly different in two groups during follow-up(P > 0.05).
【Conclusions】Retroperitoneal laparoscopy nephroureterectomy has the advantages of less wound ,less blood loss ,less complications,complete specimen,rapid recovery and fitting the surgery principle of tumor radical treatment etc. It has become an ideal surgical technique for treating the transitional cell carcinoma of upper urinary tract.
目的:比较上尿路移行细胞癌行后腹腔镜肾输尿管全切除术与开放手术的临床疗效。
方法:36例上尿路移行细胞癌患者行后腹腔镜下肾输尿管全切除术(A组),并与同期29例开放手术(B组)进行对比。对两组患者的手术时间、术中失血量、肠功能恢复时间、止痛剂使用量和住院时间等进行统计分析。并对患者随访4-36个月,比较两组的生存率、膀胱肿瘤复发情况。
结果:所有手术均成功完成,无死亡病例,A组无中转开放手术病例。平均手术时间A组(156±28)min,B组(138±19) min (P <0.05);术中出血A组(120±30) ml,B组(180±29)ml,(P <0.01);术后肠功能恢复时间A组(36.7±8.2)h,B组(37.2±7.2) h( P >0. 05);术后止痛药物使用剂量A组(38.6±15.1)mg ,B组(50.9±19.7)mg( P < 0.05),平均住院天数A组(8.7±1.3)d ,B组(9.2±1.8)d( P > 0.05)。后腹腔镜组(A组)平均手术时间略长于开放手术组(B组)(P<0.05)。后腹腔镜组平均术中出血量、平均术后止痛药物剂量均少于开放组(P<0.05);两组平均术后肠功能恢复时间、平均术后住院天数相比差别无统计学意义(P>0.05);随访4～36个月,两组膀胱复发率相比无统计学意义(P>0.05)。
结论:后腹腔镜下肾输尿管全切除术具有创伤小、出血少、并发症少、切除标本完全、恢复快、符合肿瘤根治外科学原则等优点,已经成为治疗上尿路移行细胞癌较理想的手术方法。
【Objective】To compare the clinical efficacy of retroperitoneal laparoscopy nephroureterectomy and open nephroureterectomy for treating the transitional cell carcinoma of upper urinary tract.
【Methods】Thirty-six patients with transitional cell carcinoma of upper urinary tract underwent retroperitoneal laparoscopy nephroureterectomy and other twenty-nine patients underwent open nephroureterectomy synchronization. The operation time,blood loss amount,recovery time of intestine function,dosage of painkiller and hospital days were compared and analyzed. All the cases were followed up for 4-36 months and the survival rates,bladder carcinoma recurrence were recorded.
【Results】All operations were completed successfully,no death occurred and there was no conversion to open surgery in group A. The mean operative time was (156±28)min in group A and (138±19) min in group B (P <0.05). The mean bleeding volume was (120±30) mL in group and (180±29) mL in group B (P <0.01). The recovery time of intestine function was (36.7±8.2)h in group A and (37.2±7.2) h in group B ( P >0. 05). The dosage of painkiller was (38.6±15.1)mg in group A and (50.9±19.7)mg in group B (P < 0.05).The hospital days in group A were (8.7±1.3)d and (9.2±1.8)d in group B (P > 0.05). The operation time in A group was similarly longer than that in the B group (P < 0. 05).The blood loss amount and dosage of painkiller in A group were shorter than those in B group (P < 0. 05). The recovery time of intestine function and hospital days were not significantly different in two groups(P > 0.05).The recurrence of bladder carcinoma was not significantly different in two groups during follow-up(P > 0.05).
【Conclusions】Retroperitoneal laparoscopy nephroureterectomy has the advantages of less wound ,less blood loss ,less complications,complete specimen,rapid recovery and fitting the surgery principle of tumor radical treatment etc. It has become an ideal surgical technique for treating the transitional cell carcinoma of upper urinary tract.
引文
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