“一体位四孔两三角法”经腹腔全腹腔镜技术治疗上尿路尿路上皮癌的临床研究

Clinical study on the treatment of upper tract urothelialcarcinoma by complete peritoneal laparoscopy with“one-position four-hole and two-triangle method”

目的探讨“一体位四孔两三角法”经腹腔全腹腔镜下肾盂癌、输尿管癌根治术治疗上尿路尿路上皮癌(UTUC)的临床疗效,探讨该术式的疗效和安全性。方法收集平顶山市平煤神马医疗集团总医院泌尿外科2009年3月至2018年10月诊断为肾盂癌、输尿管癌并接受手术治疗的患者资料,共计85例。根据采用的术式将其分为两组进行对比研究。A组为“一体位四孔两三角法”经腹腔途径完全腹腔镜组,共计39例;B组为经腹膜后途径腹腔镜联合经尿道输尿管口电切术组,共计46例。将两组患者的年龄、肿瘤大小、肿瘤部位、手术时间、失血量、术后胃肠功能恢复时间、术后尿管留置时间、术后引流管留置时间和术后住院天数及两组患者术后随访期间有无种植、膀胱肿瘤复发、局部复发、远处转移等参数进行统计学分析。结果两组患者在年龄、肿瘤大小、肿瘤部位、术后胃肠功能恢复时间、失血量、肿瘤病理分期、肿瘤病理分级、术后复发转移率方面差异均无统计学意义(P>0.05)。A组在手术时间、术后引流管留置时间、尿管留置时间、术后住院天数方面均优于B组,差异有统计学意义(P<0.01)。结论“一体位四孔两三角法”经腹腔全腹腔镜下肾盂、输尿管癌根治术不需要在术中更换体位,具有手术操作空间大、术中解剖学标志多、容易学习、出血少、康复快、住院时间短等优点,是一种治疗UTUC理想的手术方式。

Objective To analyze and discuss the efficacy and safety on the treatment of urothelial carcinoma of the upper urinary tract with the technique of transperitoneal complete laparoscopic nephroureterectomy by comparing with retroperitoneal laparoscopy combined with transurethral electrotomy of the ureteral orifice.Methods A total of 85 patients who were diagnosed with renal pelvic cancer and ureteral cancer from March 2009 to October 2018 and underwent surgical treatment were collected.According to the operation method,the patients were divided into two groups for comparative study.Thirty-nine cases,who received the technique of transperitoneal complete laparoscopic nephroureterectomy with“position four-hole and two-triangle method”were assigned to group A,while 46 cases who received the technique of retroperitoneal laparoscopy combined with transurethral electrotomy of the ureteral orifice were assigned to group B.Parameters such as the patient's age,tumor size,tumor location,surgical time,blood loss,postoperative gastrointestinal function recovery time,postoperative catheter indwelling time,postoperative drainage tube indwelling time,postoperative hospitalstay days as well as the implantation metastasis,bladder tumor recurrence,local recurrence and distant metastasis were collected for statistical analysis.Results There was no statistically significant differences in age,tumor size,tumor site,postoperative recovery time of gastrointestinal function,blood loss,tumor pathological stage,tumor pathological grade,postoperative recurrence or metastasis rate between the two groups(P>0.05),However,Group A was superior to group B in operation time,postoperative indwelling time of drainage tube,indwelling time of catheter and postoperative hospitalstay,which showed statistically significant differences(P<0.01).Conclusions The technique of transperitoneal complete laparoscopic nephroureterectomy with“one-position four-hole and two-triangle method”is an ideal operation method for the treatment of upper tract urothelial carcinoma becaus of one intraoperative position,a large operation space,more intraoperative anatomical marks,more easy to learn,less bleeding,rapid recovery and shorter hospitalstay.