治疗与移植肾同侧的自体肾盂输尿管肿瘤术式的对比分析

Comparative analysis of operation modes for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney

目的分析治疗肾移植术后并发与移植肾同侧的自体肾盂输尿管肿瘤的三种手术方式的优缺点，探讨最适合的手术方式。方法回顾分析48例次肾移植术后并发与移植肾同侧的自体肾盂输尿管肿瘤患者的临床资料，其中开放手术组（开放组）14例，腹腔镜加下腹斜切口组（腹切组）22例次，改良Plunk法腹腔镜组（Plunk法组）12例次，对比分析三组的手术时间、术中出血量、输血量、术后肠道功能恢复时间、术后引流管留置时间、切口拆线时间、住院总费用、住院时间及并发症发生率等指标。结果开放组手术时间为（143±38）min，短于腹切组的（221±57）min和Plunk法组的（188±114）min。Plunk法组术后肠道功能恢复时间和切口拆线时间少于其他两组（P〈0．05），但出血量和并发症发生率要高于腹切组（P〈0．05）；而腹切组与其他两组比较，术中出血量最少（P〈0．01），并发症发生率也最低，为4．5%（1／22），但与另两组相比较，差异无统计学意义（P〉0．05）。结论腹腔镜加下腹部斜切口手术治疗肾移植术后并发自体肾盂输尿管肿瘤，手术安全性高，创伤小，治疗效果满意，尤其适用于位于移植肾同侧的肿瘤。

Objective To explore the different operation modes for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney. Method A retrospective analysis was performed on 48 cases of native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney, including 14 cases receiving open surgery （open surgery）, 22 cases receiving laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision （oblique incision group） and 12 cases receiving modified endoscope assisted Plunk technique （Plunk group）. The operating time, amount of bleeding and blood transfusion during operation, recovery of intestinal function, time of indwelling drainage tube and wound suture, the total cost of hospitalization, the hospital stay and the incidence of complications were comparatively analyzed. Result The operating time in open group was shortest. Group of Pluck is better than other groups in the aspects of Time of wound suture and intestinal function time in shorter in Plunk group than the rest two group （P〈0. 05）, and amount of bleeding and incidence of complication in Plunk group were higher than oblique incision group （P〈0. 05）. The incidence of complications and amount of bleeding were decreased significantly as compared with the rest groups （P〈0. 05）. Conclusion The mode of the laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision has the advantages of high security, minimal invasion and satisfactory treatment effect. It is especially suitable for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney.