经腹途径与腹膜后途径下根治性肾输尿管全切术的比较分析

Comparison of laparoscopic radical nephroureterectomy by transperitoneal versus extraperitoneal approach

目的:比较经腹途径与腹膜后途径下根治性肾输尿管全切术的疗效及安全性。方法:回顾性分析2013年3月~2016年4月行腹腔镜下根治性肾输尿管全切术患者的临床资料,根据时间顺序分为经腹腹腔镜根治性肾输尿管全切术(TLNU)18例和腹膜后腹腔镜下根治性肾输尿管全切术(RLNU)17例,收集统计所有患者的一般临床资料及围手术期资料。结果:两组手术均顺利完成,无中转开放者。TLNU组和RLNU组在患者年龄、性别、BMI、肿瘤患侧及肿瘤位置等方面比较差异均无统计学意义(P>0.05)。两组的肠道功能恢复时间分别为(2.8±1.7)d和(2.0±1.4)d,术后住院时间分别为(6.7±2.1)d和(5.6±1.8)d,差异均有统计学意义(P<0.05)。两组的手术时间[(118.2±24.3)min vs.(109.3±31.8)min]、手术估计出血量[(125.6±45.2)mL vs.(111.9±43.6)mL]、引流管拔除时间[(3.5±1.9)d vs.(3.6±2.0)d]、导尿管拔除时间[(6.9±2.8)d vs.(7.2±3.1)d]比较差异无统计学意义(P>0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论:经腹和腹膜后腹腔镜途径治疗上尿路尿路上皮癌是安全、有效的。相对于经腹途径,腹膜后途径有着更短的术后肠功能恢复时间及住院时间。

Objective:To compare the safety and oncological results of laparoscopic radical nephroureterectomy performed between transperitoneal and extraperitoneal approach.Method:Selected patients who underwent laparoscopic radical nephroureterectomy were divided into two groups:the transperitoneal group(18 patients)and retroperitoneal group(17 patients).Result:All procedures were performed successfully without conversion.There was no difference between two groups in terms of age,sex,BMI,tumor side or tumor location.Time to first oral take of transperitoneal group was longer than that of retroperitoneal group[(2.8±1.7)d vs.(2.0±1.4)d,P<0.05].Postoperative hospital stay oftransperitoneal group was longer than that of retroperitoneal group[(6.7±2.1)d vs.(5.6±1.8)d,P<0.05].No significant difference was found between two groups in the terms of procedure time,estimated blood loss,duration of incision drainage tube,duration of catheterizationor complications(P>0.05).Conclusion:Both transperitoneal and retroperitoneal laparoscopicradical nephroureterectomy are safe and effective.However,the retroperitoneal approach can provide fastergastrointestinal function recovery and shorter postoperative hospital stay.