腹腔镜Boari膀胱壁瓣法输尿管膀胱再植术治疗中下段输尿管尿路上皮癌的临床效果

Efficacy and outcomes of laparoscopic ureteroneocystostomy with a Boari flap for the treatment of urothelial carcinoma in middle and distal ureter

目的探讨腹腔镜Boari膀胱壁瓣法输尿管膀胱再植术(laparoscopic ureteroneocystostomy with a Boari flap,LUBF)治疗中下段输尿管尿路上皮癌的可行性和预后。方法筛选首都医科大学附属北京朝阳医院泌尿外科2005至2016年的数据库,共19例患者因原发性中下段输尿管尿路上皮癌接受LUBF治疗(2D腹腔镜治疗5例,3D腹腔镜治疗14例),其中,男12例,女7例,中位年龄68.0(60.0,75.0)岁,术前肾积水中度12例,重度3例,统计患者的围手术期数据、病理结果和随访结果。结果19例患者的手术均为腹腔镜下完成,未中转开放手术。手术时间180.0(145.0,210.0)min,出血量50.0(20.0,100.0)mL,住院天数14.0(12.0,18.0)d,术前和术后血清肌酐(serum creatinine,SCr)分别为(94.1±25.2)μmol/L和(88.9±32.2)μmol/L,术后1年和3年总生存率(overall survival,OS)分别为94.4%和82.6%。与2D腹腔镜手术相比,3D腹腔镜治疗的手术时间更短(P=0.033),术中出血量更少(P=0.044)。结论LUBF手术时间短、出血量少、创伤小,能帮助改善患者肾功能,是一种值得推广的手术方式;与传统2D腹腔镜技术相比,3D-LUBF具有明显的手术时间和失血量优势。

Objective To investigate the efficacy and outcomes of laparoscopic ureteroneocystostomy with a Boari flap(LUBF)for the treatment of middle and distal ureteral carcinoma.Methods Totally 19 cases(12 males and 7 females)of primary solitary middle or distal ureteral carcinoma in the department of urology at Beijing Chaoyang Hospital,Capital Medical University from 2005-2016 were screened and enrolled,who were treated with LUBF(5 cases treated with 2D laparoscopy,14 cases treated with 3D laparoscopy).The median age was 68.0(60.0,75.0)years old.12 patients were diagnosed with moderate hydronephrosis,3 patients with severe hydronephrosis.The clinical data including perioperative data,pathology results and follow-up results and collected.Results All 19 cases were completed successfully without transited to open surgery.The median operation time was 180.0(145.0,210.0)min.The median estimated blood loss was 50.0(20.0,100.0)mL.The median hospital stay was 14.0(12.0,18.0)days.The mean preoperative and postoperative serum creatinine(SCr)were(94.1±25.2)μmol/L and(88.9±32.2)μmol/L,respectively.The 1-year and 3-year overall survival were 94.4%and 82.6%,respectively.Comparing 2D and 3D methods with each other,the 3D method could be accomplished with shorter operative time(P=0.033)and less blood loss(P=0.044).Conclusions LUBF is a feasible method in treating middle and distal ureteral carcinoma,which can be accomplished with less blood loss and short operation time by a minimally invasive way.The surgery can also help improve renal function.Compared with 2D traditional laparoscopic technique,3D-LUBF showed significant advantages in operation time and blood loss.