45°一站式斜仰卧位腹腔镜上尿路上皮癌根治术

45°One-stop Oblique Supine Position Laparoscopic Radical Resection of Upper Tract Urothelial Carcinoma

目的探讨45°一站式斜仰卧位腹腔镜上尿路上皮癌根治术治疗上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)的安全性和有效性。方法2019年8月~2020年7月我院采用45°一站式斜仰卧位经腹腔途径腹腔镜上尿路上皮癌根治术治疗12例上尿路上皮癌。患侧与手术台水平面成45°斜仰卧位,脐水平腹正中线向患侧旁4 cm取1 cm切口置入10 mm trocar,建立CO_(2)气腹,以此孔作为观察孔(A)置入腹腔镜,直视下分别建立另外3个操作孔(B、C、D)和1个辅助孔(E),其中B孔位于A孔垂直向上4 cm处,C孔水平向外侧4 cm处,D孔为A孔下内侧2 cm。30°腹腔镜探查腹腔,以A孔为观察孔,B、C孔为操作孔,完整游离肾及上段输尿管。腹腔镜监视器转移至患者足端,以A孔为观察孔,C、D孔为操作孔分离并完整切除输尿管下段和膀胱壁内段。在整个手术过程中,E孔为辅助暴露术野。结果12例均一期完成手术,手术时间65~90 min,平均75 min;出血量30~100 ml,平均50 ml;无输血、肠管、内脏器官副损伤并发症,无腹腔内及切口感染。11例术后随访12个月,无术后种植转移。结论45°一站式斜仰卧位腹腔镜UTUC根治术治疗UTUC是安全可行的。

Objective To investigate the safety and efficacy of 45°one-stop oblique supine position laparoscopic radical resection of upper tract urothelial carcinoma(UTUC).Methods From August 2019 to July 2020,12 cases of UTUC were treated with laparoscopic radical resection under 45°one-stop oblique supine position via abdominal approach in our hospital.The affected side was placed in a 45°oblique supine position with the horizontal plane of the operating table.A 1 cm incision was taken at 4 cm from the midline of the umbilicus to the affected side and a 10 mm trocar was inserted to establish CO2 pneumoperitoneum.This hole was used as the observation hole(A)through which the laparoscope was placed into.Under direct vision,another 3 operation holes(B,C,D)and 1 auxiliary hole(E)were established,where the hole B was located at 4 cm vertically upward of the hole A,the hole C was 4 cm horizontally outward,and the hole D was 2 cm below the inner side of the hole A.The abdominal cavity was explored by a 30°laparoscope.With the hole A as the observation hole,the hole B and hole C as the operation holes,the kidney and upper ureter were completely resected.Then the laparoscopic monitor was transferred to the foot-side of the patient,and the hole A was used as the observation hole and the holes C and D were used as the operation holes to separate the lower ureter segment and the inner bladder wall segment completely.During the whole operation,the hole E was used as the auxiliary exposure field.Results The operations in all the 12 patients were completed in one stage.The operation time was 65-90 min(mean,75 min).The blood loss was 30-100 ml(mean,50 ml).There were no need for blood transfusion or complications of intestinal and visceral injury.All the patients were followed up for 12 months without postoperative implantation metastasis.Conclusion The 45°one-stop oblique supine position laparoscopic radical resection of UTUC is safe and feasible.