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

Retroperitoneal laparoscopic nephroureterectomy in 103 cases with upper urinary tract urothelial carcinoma

目的:探讨上尿路尿路上皮癌行后腹腔镜下肾输尿管切除术的临床效果.方法:回顾性分析2003年1月～2012年3月因上尿路尿路上皮癌行后腹腔镜下肾输尿管切除术的103例患者的临床资料,其中后腹腔镜联合腹部小切口肾输尿管切除术94例,后腹腔镜联合经尿道膀胱输尿管开口电切9例.结果:103例手术均获成功,无术中转开放手术.平均手术时间(165±52)min,术中平均出血量(125±53)ml,术后平均住院时间(6.4士4.1)d.术中术后未发生严重并发症.术后病理诊断均为尿路上皮癌,Ta 10例,T1 43例,T2 27例,T3 23例.术后平均随访55(6～90)个月,17例术后发生膀胱肿瘤,4例术后发生肺部转移,7例患者死亡,其中4例发生肺部转移者均于术后2年死亡.结论:后腹腔镜下肾输尿管切除术具有术程短、出血少、创伤小、恢复快等优点,术后近期疗效好,远期疗效需要进一步评价.

Objective:To evaluate the clinical effectiveness of retroperitoneal nephroureterectomy for upper urinary tract urothelial carcinoma.Methods:Between January 2003 and March 2012,clinical data of 103 cases with upper urinary tract urothelial carcinoma,which were treated with retroperitoneal larparoscopic nephroureterectomy,was retrospectively analyzed.Total 94 cases underwent retroperitoneal laparoscopic nephroureterectomy combined with the abdominal incision,whereas the other 9cases underwent retroperitoneal laparoscopy combined with transurethral resection of ureteric orifice.Results:The operations were completed successfully in all 103 cases.There was no conversion to open surgery.The mean operation time was(165±52)min,the mean blood loss was(125±53)ml.The postoperative hospitalization stay was(6.4±4.1)d.There were no severe peri-operative complications.Pathological examination showed transitional cell carcinoma in all the cases,with Ta10 cases,T143cases,T227 cases,T323cases.During the follow-up of 55(6-90)months,bladder cancer was found in 17 cases,pulmonary metastasis was found in 4 cases.Seven cases died during follow-up,while all of the 4cases with pulmonary metastasis passed away within 2year postoperatively.Conclusions:Retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma is characterized by short operation time,less bleeding,minimal trauma and quick recovery.The short-period effect is good while the long-term effect needs to be further investigated.