经腹与经腹膜后腹腔镜肾输尿管全长切除治疗上尿路尿路上皮癌的临床研究

Clinical Study of Transabdominal or Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Cancer with Bladder-cuff Resection

目的探讨经腹膜后入路腹腔镜肾输尿管全长切除联合膀胱袖状切除术治疗上尿路尿路上皮癌的可行性和安全性。方法将62例尿路上皮癌患者分为经腹腔入路组和经腹膜后入路组。经腹腔入路组患者均接受经腹腔入路腹腔镜肾输尿管全长切除联合膀胱袖状切除术治疗;而经腹膜后入路组患者则接受经腹膜后入路肾输尿管全长切除联合下腹部小切口膀胱袖状切除术治疗。观察并记录2组患者手术时间、术中出血量和住院时间等手术相关指标。术后观察2组患者术后并发症、肿瘤复发和转移情况,并于术前和术后3个月采用SF-36量表对患者的生活质量进行评分。结果经腹膜后入路组患者的手术时间、术中出血量和住院时间分别为(118.74±22.68)min、(124.69±43.78)mL和(8.12±2.21)d,均显著低于经腹腔入路组的,组间差异有统计学意义(P<0.05);经腹膜后入路组患者术后3个月的生理功能、生理职能、躯体疼痛、总体健康、社会功能、活力、情感职能和精神健康共8个维度的评分均高于经腹腔入路组(P<0.05);经腹膜后入路组患者术后的并发症发生率为3.12%,显著低于经腹腔入路组的13.33%(P<0.05)。2组患者术后彩超和膀胱镜检查均未发现肿瘤复发情况;2组患者术后远处转移发生率比较,差异无统计学意义(P>0.05)。结论经腹膜后入路肾输尿管全长切除联合下腹部小切口膀胱袖状切除术治疗上尿路尿路上皮癌,创伤小,利于患者的康复,同时可提高患者的生活质量,安全有效,值得应用于临床。

Objective To discuss the effectiveness and of security upper urinary tract cancer treated with transabdominal or retroperitoneal laparoscopie nephrouretereetomy with bladder-cuff resection. Methods 62 patients with upper urinary tract cancer were retrospective analyzed. According to the different surgery, 30 patients treated with transabdominal laparoscopic nephroureterectomy with bladder-cuff resection and excision of cuff of bladder taken as transabdominal group, while 32 patients received retroperitoneal laparoscopic nephroureterectomy with bladder-cuff resection and excision of cuff of bladder were taken as retroperitoneal group. Observed and recorded the operation time,intraoperative blood loss and hospital stays. Observed the complications, tumor recurrence and tumor metastasis. Evaluated the quality of life in the 2 groups 3 months before and after operation. Results The operation time, intraoperative blood loss and hospital stays were （ 118.74 ± 22.68 ） min, （ 124.69 ±43.78 ） mL and （8.12 ± 2.21 ）d in retroperitoneal group ,which were all lower than that in transabdominal group;The hysiological function, physiological function, body pain, general health, social function, dynamic, emotional functions and mental health eight dimensions of life quality scores of retroperitoneal group after 3-months operation were also higher than that in transabdominal group, differences were statistically significant （P 〈 0. 05 ）. The incidence rate of complication was 3.12% in retroperitoneal group after operation, which lower than that in transabdominal group, differences were statistically significant （ P 〈 0.05 ）. There were no neoplasm recurrence in the 2 groups. The occurrence rate of distant metastasis had no statistical difference （ P 〉 0.05 ）. Conclusion Upper urinary tract cancer treated with transabdominal or retroperitoneal laparoseopie nephroureterectomy with bladder-cuff resection and excision of cuff of bladder can shorten the operation time and hospital stays, improve the quality of life, it is beneficial to recovery, which has less trauma, and it is worthy to clinical use.