不同根治手术在肾盂癌治疗中的比较

Comparison of different radical resection of renal pelvis carcinoma

目的 比较经尿道输尿管口袖口状电切联合后腹腔镜肾切除与后腹双切口开放手术在肾盂癌治疗中的疗效及不良反应。方法回顾性分析2001年7月至2009年7月42例经尿道输尿管口袖口状电切联合后腹腔镜肾切除（微创手术组）与20例后腹双切口开放手术（开放手术组）进行肾盂癌根治术患者的资料，通过对手术时间、出血量、中转开放情况、术中及术后并发症、住院时间、术后肿瘤复发及转移例数等数据的统计，对两种术式的操作步骤及手术经验进行比较。结果微创手术组与开放手术组比较，手术时间[（147．34±39．16）和（158．88±42．12）min]、下地活动时间[（3．58±0．79）和（5．67±1．24）d]、住院时间[（9．15±2．19）和（11．64±3．71）d]明显缩短（t值分别为3．3167、2．0587、8．0494，P值均〈0．05），术中出血量[（70．64±27．33）和（118．17±44．65）ml]明显降低（t=5．1777，P〈0．05）。但在手术初期，微创手术组有4例患者腹腔镜手术中转开放手术。术后随访8～48个月，微创手术组与开放手术组远处转移率分别为2．4％（1／42）和5．0％（1／20），局部复发率为4．8％（2／42）和5．0％（1／20），术中并发症发生率分别为4．8％（2／42）和5．0％（1／20），术后并发症发生率均为0，2组患者远处转移及局部复发率、术中及术后并发症发生率差异均无统计学意义（P〉0．05）。结论后腹腔镜联合经尿道输尿管口袖状电切治疗肾盂癌与开放手术相比具有创伤小、解剖层次清晰、术中出血少、术后恢复快等特点，治疗效果及术后肿瘤复发等情况与开放手术相似。

Objective To investigate the surgical technique and clinical effectiveness of retroperitoneal laparoscopic nephroureterectomy with transurethral bladder-cuff excision and open nephrouretereetomy in pelvis carcinoma. Methods We retrospectively analysed the records of all 62 patients who underwent retroperitoneal laparoscopic or open nephrouretereetomy in Tianjin Dagang Hospital or the Second Affiliated Hospital of Tianjin Medical University from July 2001 to July 2009. Variables analyse were compared including operative time, blood loss, turning to open operation, complications, length of stay, tumor recurrence and metastasis. Groups were compared using Student＇s t -test, and a probability （P） value of less than 0.05 was taken to indicate statistical significance. Results The respective mean operative duration [（47.34±39.16） vs （118.17±44.65） roll, length of hospital stay [（9.15±2.19） vs （11.64±3.71） d], time to ambulation [（3.58±0.79） vs （5.67±1.24） d] and blood loss [（70.64±27.33） vs （118.17±44.65） roll in retroperitoneal laparoscopic nephroureterectomy with transurethral bladder-cuff excision group was significantly reduce to open nephroureterectomy group （t = 3.3167, 2.0587, 8.0494, 5.1777, P 〈0.05）. There was no significantly difference between two groups in complication of during operation and post operation [4.8 % （2/42） vs 5.0 % （1/20）, 0 vs 0, respectively] （P 〉0.05）. 4 cases were failed and conversed to open surgery in retroperitoneal ]aparoscopic nephroureterectomy group. During the follow up period range from 8-48 months, there was no significantly difference between two groups in tumor recurrence and metastasis [4.8 % （2/42） vs 5.0 % （1/20）, 2.4 % （1/42） vs 5.0 % （1/20）, respectively] （P 〉0.05）. Conclusion Retroperitoneal laparoscopy in upper urinary tract transitional carcinoma uses a small incision, incurs less blood loss, and allows for a more rapid recovery, suggesting it is a safe and effective method for treating patients with renal and pelvis cancer.