后腹腔镜与开放手术治疗上尿路尿路上皮癌的疗效比较

A Comparison of Therapeutic Effect of Retroperitoneal Laparoscopic and Open Surgery in the Treatment of Upper Tract Urothelial Carcinoma

目的比较后腹腔镜与开放手术治疗上尿路尿路上皮癌的疗效。方法回顾性分析我院2005年7月～2016年12月105例手术治疗上尿路尿路上皮的临床资料,其中80例后腹腔镜肾输尿管切除术(RLNU组),25例开放肾输尿管切除术(ONU组),比较2期围手术期指标及随访结果。结果 2组手术时间无统计学差异[(220.6±68.5)min vs.(218.4±85.3)min,t=-0.130,P=0.897]。RLNU组术中出血量中位数明显少于ONU组[100(50,200)ml vs.150(100,700)ml,Z=-2.694,P=0.007];通气时间明显短于ONU组[(2.6±0.6)d vs.(3.2±0.7)d,t=3.791,P=0.000];术后住院时间明显短于ONU组[(10.1±3.7)d vs.(14.3±9.3)d,t=2.189,P=0.038];术后并发症发生率明显低于ONU组(15.0%vs.48.0%,χ~2=11.764,P=0.001)。术后随访2～96个月,RLNU组和ONU组膀胱癌复发分别为18例和5例,远处转移分别为6例和0例,累积生存率无统计学差异(log-rank χ~2=0.474,P=0.491)。结论后腹腔镜手术是治疗上尿路尿路上皮癌安全、有效的方法。

Objective To compare the efficacy of retroperitoneal laparoscopic versus open radical nephroureterectomy for upper tract urothelial carcinoma. Methods From July 2005 to December 2016,105 radical nephroureterectomy were performed in our institution. A retrospective review was carried out,including 80 cases of retroperitoneal laparoscopic approach（ RLNU group） and 25 cases of open technique（ ONU group）. The perioperative data and follow-up results were compared. Results There was no significant difference in operation time between the two groups [（ 220. 6 ± 68. 5） min vs.（ 218. 4 ± 85. 3） min,t =-0. 130,P =0. 897]. As compared with the ONU group,the intraoperative blood loss was significantly less in the RLNU group [100（ 50,200） ml vs. 150（ 100,700） ml,Z =-2. 694,P = 0. 007]. The postoperative anal exhaust time was shorter in the RLNU group [（ 2. 6 ±0. 6） d vs.（ 3. 2 ± 0. 7） d,t = 3. 791,P = 0. 000]. The length of postoperative hospitalization days was shorter in the RLNU group[（ 10. 1 ± 3. 7） d vs.（ 14. 3 ± 9. 3） d,t = 2. 189,P = 0. 038]. The incidence of postoperative complications was lower in the ONU group（ 15. 0% vs. 48. 0%,χ^2= 11. 764,P = 0. 001）. Postoperative follow-up was conducted for 2-96 months. There were 18 cases and 5 cases of recurrence of bladder cancer in the RLNU group and the ONU group during the follow-up,respectively. The distant metastasis was found in 6 cases in the RLNU group and 0 case in the ONU group. The overall survival rate was not significantly diffenent（ log-rank χ^2= 0. 474,P = 0. 491）. Conclusion Retroperitoneal laparoscopic surgery is a safe and effective method to treat upper tract urothelial carcinoma.