摘要
目的 通过分析航天中心医院泌尿外科近6年来采用的一种创新的三孔法完全后腹腔镜下上尿路尿路上皮癌根治术的临床疗效,探讨该术式的安全性及可行性.方法 回顾性分析2013年6月至2019年6月航天中心医院泌尿外科收治的68例行上尿路尿路上皮癌根治术的临床资料,50例患者采用完全后腹腔镜下全肾输尿管切除术(CRNU),其中38例患者采用完全三孔法后腹腔镜下全肾输尿管切除+膀胱袖状切除术,12例因输尿管下段粘连较重、肿瘤位于输尿管末端或操作空间狭小,于改良三孔法基础上增加1个(四孔)完成.另外18例患者采用传统后腹腔镜肾输尿管切除术(TRNU)完成.分别收集各组患者的临床资料、疗效以及术后并发症情况,比较CRNU组与TRNU组的临床疗效.结果 各组患者的临床资料差异无统计学意义(P＞0.05),所有患者均顺利完成手术,输尿管切缘均为阴性,均未出现严重并发症.CRNU组在平均手术时间、平均失血量、引流管拔除时间、平均住院时间、住院费用、肠功能恢复时间方面明显优于TRNU组;四孔和三孔在平均手术时间、平均失血量、引流管拔除时间、平均住院时间、住院费用、肠功能恢复时间差异无统计学意义.术后1 h、12 h的疼痛评分CRNU组优于TRNU组,而三孔与四孔比较差异无统计学意义.CRNU组平均随访时间为35.4个月,TRNU组平均随访时间为26.5个月.CRNU组2例患者失联,其余随访患者均无局部复发.两组患者均未出现局部复发.CRNU组2例膀胱肿瘤复发,TRNU组4例膀胱肿瘤复发.结论 基于三孔法完全后腹腔镜下创新与改良的上尿路尿路上皮癌根治术临床疗效满意,创伤小,手术效果好,是一种安全、有效、经济的治疗方法,对于困难的输尿管下段切除可加1个辅助孔,有助于手术顺利完成.
Abstract
Objective To explore the safety and feasibility of an innovative three-hole laparo-scopic radical resection of upper urinary tract epithelial carcinoma,which has been used in our de-partment for the past 6 years,by analyzing the clinical efficacy of this method.Methods A retro-spective analysis was conducted on the clinical data of 68 patients with upper urinary tract epithelial carcinoma undergoing radical surgery in the Department of Urology of the Aeropace Center Hospital from June 2013 to June 2019.Among them,50 patients underwent complete retroperitoneal laparo-scopic nephroureterectomy(CRNU).Thirty-eight patients underwent total retroperitoneal laparo-scopic nephroureterectomy plus bladder cuff resection using the complete three-hole method,while 12 patients underwent the same surgical procedure by complete three-hole plus one method because of severe adhesion of the lower ureter,tumor location at the distal end of the ureter and a narrow op-erating space.Another 18 cases underwent traditional retroperitoneal laparoscopic nephroureterecto-my(TRNU),which involved a combination of retroperitoneal laparoscopy and a lower abdominal in-cision for total nephroureterectomy.The clinical data,efficacy,and postoperative complications of patients in each group were collected,and the clinical efficacy of the CRNU group and the TRNU group was compared.Re-sults There was no statistically significant difference in the clinical data of patients among groups(P＞0.05).All patients were successfully completed the surgery,without positive ureteral margins or serious complications.The CRNU group was significantly superior in terms of average surgical time,average blood loss,drainage tube removal time,average hospital stay,hospital expenses,and intestinal function recovery time.There was no significant difference between the four and three holes in average surgical time,average blood loss,drainage tube removal time,average hospital stay,hospital expenses,or intestinal function recovery time.The pain scores in the CRNU group were better than those in the TRNU group at 1h and 12h after sur-gery,but there was no significant difference between the three holes and the four holes.The average follow-up time in the CRNU group was 35.4 months,while the average follow-up time in the TRNU group was 26.5 months.In the CRNU group,2 patients failed,and the rest of the follow-up patients had no local recurrence.No local recurrence occurred in both groups of patients.There were 2 cases of bladder tumor recurrence in the CRNU group and 4 cases of bladder tumor recurrence in the TRNU group.Conclusions The innovative and improved retroperitoneal laparoscopic radical surgery for upper urinary tract epithelial carcinoma based on the three-hole method has satisfactory clinical efficacy,minimal trauma,and good surgical re-sults.It is a safe,effective,and economical treatment method.For difficult lower ureterectomy,an auxiliary hole can be add-ed,which is conducive to the smooth completion of the operation.
维普
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