完全腹腔镜下肾、输尿管及膀胱袖状切除术治疗上尿路肿瘤的临床研究

目的分析利用腹腔镜技术进行肾、输尿管及膀胱袖状切除的方式对上尿路肿瘤患者进行治疗的临床意义。方法对于2013年9月至2015年3月期间12例上尿路蹦，瘤患者，在全麻状态下进行完全腹腔镜下的肾、输尿管以及膀胱的袖状切除手术，所有标本均由脐以及下腹正中的切口取出。对所有患者手术期间及术后的棚关临床指标进行记录与分析。结果所有患者均成功完成手术．未出现需中转开放手术的情况．未她有关手术并发症。患者手术的时间范围为150～240min，平均为189．0±30．8min。手术期间失血量约为80～650ml，平均90．5±50ml。引流管的保留时间范围为3～15d，平均6．2±5．1d。肠功能恢复耗时约2～5d，平均1.6±1．5d。患眷术后1至4天即可下床活动。住院3～28d，平均13．1±6．8d。12例患者手术后病理检测均为尿路上皮癌．其中包括10例肾蟊癌，1例输尿管癌，1例肾需输尿管连接处癌；7例商级别，5例低级别。所有患者手术标本的切缘均呈阴性。术后随访期间，患者均未出现肿瘤复发或者转移等情况。结论完全腹腔镜下进行肾、输尿管及膀胱袖状切除以治疗上尿路肿瘤，具有疗效好，安全性商．创伤小，患者术后恢复状态优等多重优点，是一项佤得临床推广与应用的治疗手段。

Objective Analyze the clinical significance of total transperitoneal laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma. Methods 12 patients from September 2013 to March 2015 were under anesthesia condition during the treatment. Samples were got from the umbilical and ventral midline incision. Clinical indicators were recorded and analyzed. Results Surgery were successfully completed, no one need to convert to open surgery, no related complications. Surgery time： 150 to 240 min, average 189. 0±30. 8min. Blood loss= 80~650 ml, average 90.5~50ml. Drainage tubc retention= 3~15d, average 6. 2± 5.1 d. Intestinal recovery： 2~5d, average 1.6-11.5d. Length of stay： 3~28 d, average 13.1~6.8d. Patients were all uruthelial carci- noma, including 10 renal pelvis carcinoma, 1 ureter caneer, 1 ureteropelvie junction caneer; 7 high level, 5 lowqevel. All samples were with negative margins. No tumor recurrence or metastasis during the follow-up. Conclusion Total transperitoneal laparoscopie nephroureterectomyin the treatment of upper urinary tract urothelial carcinoma is efficacy, safety, trauma and muhiple advantages. This is worth clinical application.