一体位完全腹腔镜下治疗上尿路移行上皮癌

Clinical study of totally laparoscopic treatment for upper urinary tract urothelial carcinoma under a single position

目的探讨一体位完全腹腔镜下治疗上尿路移行上皮癌的手术方法及临床效果。方法选取2016年1月至2017年6月至烟台毓璜顶医院就诊的89例上尿路移行上皮癌患者为研究对象,采用前瞻性临床对照研究方法,按照随机数字表法将患者分为实验组与对照组。实验组(n=45)手术方式选择一体位完全腹腔镜下上尿路移行上皮癌根治术,对照组(n=44)采用后腹腔镜联合下腹部斜行小切口治疗上尿路移行上皮癌。对比两组患者的围手术期相关指标及肿瘤复发情况的差异,分析一体位完全腹腔镜下治疗上尿路移行上皮癌的临床效果。结果实验组与对照组均顺利完成手术,术中均无中转开放,围术期均未出现明显的并发症。实验组患者的平均手术时间(96.6±8.6) min、术中出血量(39.6±4.2) ml、术后首次下床活动时间(7.5±1.0) h以及平均住院时间(7.0±1.1) d与对照组患者相比(147.5±9.2) min,(46.5±4.6) ml,(11.4±1.8) h,(9.9±1.5) d,其差异有统计学意义(P<0.05),而两组患者的肿瘤分期、肿瘤分级、胃肠功能恢复时间、随访时间及术后肿瘤复发情况的差异无统计学意义(P>0.05)。结论一体位完全腹腔镜下治疗上尿路移行上皮癌较传统术式具有手术时间短、术中出血量少、术后首次下床活动时间早等优势,可缩短患者的住院时间,加速患者康复,是切实可行的术式,值得临床推广应用。

Objective To investigate the clinical efficacy of totally laparoscopic treatment for upper urinary tract urothelial carcinoma(UUTUC)which under a single position.Methods Eighty nine UUTUC patients were enrolled from Jan.2016 to Jun.2017.The prospective clinical controlled analysis method was adopted in our study.All patients were divided into test group and control group according to the random number table.Fourty five cases(test group)underwent totally laparoscopic nephroureterectomy with single position,while 44 cases(control group)received retroperitoneal laparoscopy combined with hypogastric oblique incision to treat the UUTUC.The differences between the two groups in perioperative related indicators and tumor recurrence rate were compared.And the clinical effect of neo-surgical treatment of UUTUC was analyzed.Results All the 89 operations for UUTUC were successful without conversion to open surgery.No obvious complications occurred during perioperative period.The average operation time in the test group was shorter(96.6±8.6)min versus(147.5±9.2)min,the blood loss was less(39.6±4.2)ml versus(46.5±4.6)ml,the leaving bed time was shorter(7.5±1.0)h versus(11.4±1.8)h,the hospital stay was shorter(7.0±1.1)d versus(9.9±1.5)d),and the difference were significant(P<0.05).There were no significant difference in tumor stage,tumor grade,the recovery time of postoperative gastrointestinal function,follow-up time and the difference of tumor recurrence rate between the 2 groups.Conclusion Compared with the traditional surgical methods,the totally laparoscopic treatment for UUTUC which under a single position has advantages of shorter operation time,less blood loss and shorter leaving bed time.The new operative method could shorten the hospital stay and accelerate recovery of patients,and it is a viable surgical procedure which deserved application and promotion in clinical work.