腹股沟切口在后腹腔镜上尿路尿路上皮癌手术中的应用价值

Application of inguinal incision in retroperitoneal laparoscopie nephroureterectomy in the treatment of upper urinary urothelial carcinoma

目的探讨腹股沟切口在后腹腔镜上尿路尿路上皮癌根治术中的应用价值。方法回顾性分析2007年3月至2012年1月186例采用后腹腔镜下肾输尿管及膀胱袖状切除术治疗上尿路尿路上皮癌患者的资料。男115例，女71例。根据标本取出切口不同分为腹股沟切口组（n=112）和腰部切口组（n=74），比较两组手术时间、术中出血量、术后镇痛治疗、患者住院时间、切口并发症、切口及周围外观满意度及肿瘤复发率的差异。结果186例手术均成功，未出现死亡和重大并发症。两组手术时间、术中出血量、肿瘤分期和肿瘤分级方面比较差异均无统计学意义（P〉0．05）。腹股沟切口组切口脂肪液化、切口疝、切口膨出、腰腹部不对称发生率以及镇痛治疗率均低于腰部切口组，住院时间短于腰部切口组，切口及周围外观满意度（I／II／III）优于腰部切口组（7／24／81和22／18／34，P〈0．01），输尿管中下段患者肿瘤复发率（5．3％）低于腰部切口组（35．0％，P〈0．01）。结论联合腹股沟切口的后腹腔镜上尿路尿路上皮癌根治术具有创伤小、切口并发症少、切口及周围外观满意度高、肿瘤复发率低等优点，值得临床推广。

Objective To evaluate the application of inguinal incision in retroperitoneal laparosco- pic nephrouretereetomy （LNU） in the treatment of upper urinary urothelial carcinoma （UUUC）. Methods From Mar. 2007 to Jan. 2012, 186 retroperitoneal LNU procedures on 115 males and 71 females for the treatment of UUUC were performed in our institute. All cases were grouped as inguinal incision group （n = 112） and lumbar incision group （n = 74） according to specimen retrieval incision. Operative time, esti- mated blood loss, postoperative analgesia, hospital stay, incision complications, cosmetic satisfaction and tumor recurrence were compared between the 2 groups. Results All the 186 cases of operation were suc- cessfully accomplished. There were no differences in tumor stage, tumor grade, mean operative time, blood loss between the 2 groups. In inguinal incision group, the incidence of incision fat liquefaction, incision her- nia, incision bulging, lumboabdominal unsymmetry and postoperative analgesia was less than that of lumbar incision group. In inguinal incision group, the mean hospital stay was shorter, cosmetic satisfaction （I/II/ III） was better （7/24/81 versus 22/18/34, P 〈0.01 ）. Recurrence rate of UUUC in middle and inferior segment of ureter was fewer than that of lumbar incision group （5. 3% versus 35. 0% , P 〈 0. 01 ）. Conclusion Retroperitoneal LNU for UUUC combined with inguinal incision offers advantage of less trau- ma, less complications, higher cosmetic satisfaction and lower tumor recurrence.