单一体位腹膜内外联合腹腔镜UTUC根治术的临床效果及安全性

Single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy in the treatment of upper tract urothelial carcinoma

目的探讨单一体位经腹腹膜内外联合腹腔镜上尿路尿路上皮癌(UTUC)根治术的安全性及有效性。方法回顾性分析2018年11月-2022年6月青岛大学附属医院采用一体位经腹腹膜内外杂交的腹腔镜下肾输尿管全切除术治疗UTUC患者共31例,其中右侧11例,左侧20例;肾盂癌14例,输尿管癌16例,肾盂及输尿管同时受累1例。结果所有31例患者的手术均顺利完成,无中转开放病例。手术时间为60~151 min,平均(81.45±19.80)min;术中出血量为30~110 mL,平均(69.03±24.13)mL。无严重术中、术后并发症发生。术后住院时间为3~17 d,术后平均住院时间为(6.13±2.44)d。术后中位随访时间28(3.0~49.0)个月。末次随访时,共有2例患者死亡,3例患者出现膀胱复发,无对侧复发病例。结论单一体位腹膜内外联合腹腔镜肾输尿管全长切除治疗UTUC,肿瘤控制效果满意,是一种安全、有效、可行的术式,值得在临床上进一步推广。

Objective To investigate the efficacy and safety of single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy in the treatment of upper tract urothelial carcinoma(UTUC).Methods Clinical data of 31 UTUC cases treated in our hospital during Nov.2018 and Jun.2022 were retrospectively analyzed,including 11 tumors in the right side,and 20 in left side.There were 14 cases of renal pelvic carcinoma,16 cases of ureter carcinoma,and 1 case of renal pelvic carcinoma plus ureter carcinoma.Results All surgeries were successfully performed without conversion to open surgery.The mean operation time was(81.45±19.80)min,and the estimated blood loss was(69.03±24.13)mL.No serious perioperative complications were observed.The average postoperative hospital stay was(6.13±2.44)d,and the median follow-up was 28(3.0-49.0)months.At the last follow-up,2 patients died,3 had recurrence,but no contralateral recurrence was observed.Conclusion Single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy is safe,effective and feasible in the treatment of UTUC.It is worth clinical popularization.