不同腹腔镜术式治疗上尿路尿路上皮癌的比较研究

Comparative Study of Different Surgical Methods in the Treatment of Upper Tract Urothelial Carcinoma

目的比较后腹腔镜肾输尿管切除联合下腹部斜切口膀胱袖状切除术与经腹完全腹腔镜肾输尿管切除联合膀胱袖状切除术治疗上尿路尿路上皮癌的手术疗效。方法回顾性分析我院2014年1月~2019年8月163例手术治疗上尿路尿路上皮的临床资料,其中A组96例(后腹腔镜肾输尿管切除联合下腹部斜切口膀胱袖状切除术),B组67例(经腹完全腹腔镜肾输尿管切除联合膀胱袖状切除术),比较2组患者围手术期资料及随访结果。结果B组手术时间(219.4±43.4)min,明显短于A组(269.5±46.5)min(t=6.956,P=0.000);A组术中出血量中位数150 ml(20~1500 ml),明显多于B组100 ml(20~600 ml)(Z=-4.325,P=0.000);B组术后住院(7.9±2.3)d,明显短于A组(9.4±3.8)d(t=3.218,P=0.002)。163例随访中位时间28个月(3~75个月),5年总生存率、疾病无进展生存率、膀胱肿瘤无复发生存率、肿瘤特异性生存率A组分别为79.0%、67.0%、80.9%、70.0%,B组分别为79.8%、75.8%、81.6%、77.0%,2组差异均无统计学意义(P>0.05)。结论2种手术方式均为治疗上尿路尿路上皮癌的微创、安全、有效的方法,但经腹完全腹腔镜术式在手术时间、术中出血量及术后住院时间方面更具优势。

Objective To compare the efficacy between retroperitoneal laparoscopy combined with oblique incision cystectomy and complete laparoscopy combined with sleeve resection of bladder for upper tract urothelial carcinoma(UTUC).Methods Clinical data of 163 cases of UTUC treated surgically in our hospital from January 2014 to August 2019 were retrospectively analyzed,including 96 cases of retroperitoneal laparoscopy combined with oblique incision of lower abdomen for bladder sleeve resection(Group A)and 67 cases of complete laparoscopy combined with sleeve resection of bladder(Group B).The perioperative indexes and follow-up results were compared between the two groups.Results The operation time of the group B[(219.4±43.4)min]was significantly less than that of the group A[(269.5±46.5)min,t=6.956,P=0.000].The intraoperative blood loss in the group A[150(20-1500)ml]was significantly more than that in the group B[100(20-600)ml,Z=-4.325,P=0.000].The postoperative hospital stay in the group B[(7.9±2.3)d]was significantly shorter than that in the group A[(9.4±3.8)d,t=3.218,P=0.002].There were 163 patients followed up after operation,and the median follow-up time was 28 months(range,3-75 months).The 5-year overall survival(OS)rate,disease free survival(DFS)rate,intra-vesical recurrence free survival(IvRFS)rate and cancer specific survival(CSS)rate of the group A were 79.0%,67.0%,80.9%and 70.0%,respectively,and of the group B were 79.8%,75.8%,81.6%and 77.0%,respectively.There were no significant differences between the two groups(P>0.05).Conclusion Both surgical methods are minimally invasive,safe and effective for the treatment of UTUC,but complete laparoscopy combined with sleeve resection of bladder has more advantages in terms of operation time,intraoperative blood loss and postoperative hospital stay.