完全后腹腔镜下肾输尿管根治术与开放手术的比较

Comparison between complete retroperitoneal laparoscopic radical nephroureterectomy and open nephroureterectomy

摘要:

目的：比较完全后腹腔镜下肾输尿管根治术与开放手术治疗上尿路移行细胞癌的临床疗效。方法：44例上尿路移行细胞癌患者行肾输尿管根治术，其中15例为腹腔镜手术组，采取完全后腹腔镜下手术，29例为开放手术组，采取开放肾输尿管根治性手术。比较2组患者的手术时间、术中出血量、术后止痛药应用时间和剂量、胃肠道功能恢复时间、下床活动时间、术后住院时间和并发症，并随访6~42月，比较2组膀胱肿瘤发生及远处转移、存活时间等。结果：2组手术均获成功。腹腔镜手术组与开放手术组比较，出血量明显减少（116.1±29.4） ml vs. （278.6±84.3） ml，P=0.000；止痛药（杜冷丁注射液）应用时间短（0.7±0.5） d vs. （2.3±0.9） d，P=0.000；剂量少（33.3±24.4） mg vs. （155.2±62.8） mg，P=0.000；下床活动早（2.1±0.5） d vs. （4.2±1.0） d，P=0.000；术后住院时间短（8.7±1.6） d vs. （13.1±3.2） d，P=0.000。腹腔镜手术组手术时间较短（212.1±19.5） min vs. （251.7±24.2） min，P=0.000，肠道功能恢复较快（1.9±0.8） d vs. （2.9±0.8） d，P=0.00１，但与开放手术组比较差异无统计学意义（P >0.05）。随访6~42月，2组病人均存活，术后并发症、肿瘤复发及转移差异无统计学意义（P >0.05）。结论：完全后腹腔镜下肾输尿管根治术具有微创并与开放手术相同的肿瘤学效果，将成为上尿路移行细胞癌的理想手术方法。

Abstract:

Objective：To compare the clinical efficacy of retroperitoneal laparoscopic radical nephroureterectomy and open nephro-ureterectomy in treating transitional cell carcinoma of the upper urinary tract. Methods：Forty-four cases of upper urinary tract transi－tional cell carcinoma were treated with radical nephroureterectomy and were divided into laparoscopy group（n=15） and open surgery group（n=29）. Patients in laparoscopy group underwent complete retroperitoneal laparoscopic nephroureterectomy while those in open surgery group underwent open nephroureterectomy. Operation time，intra-operative blood loss volume，post-operative painkiller appli－cation dosage and time，recovery time of intestinal function，time of getting out of bed，length of hospital stay and complications were compared and analyzed. All cases were followed up for 6-42 months，survival rates，incidences of bladder carcinoma recurrence and distant metastasis were recorded and compared. Results：Operations of both groups were successfully performed. Blood loss volume and application dosage of painkiller were fewer in laparoscopy group than in open surgery group （116.1±29.4） ml vs. （278.6±84.3） ml，（33.3±24.4） mg vs.（155.2±62.8） mg，P=0.000. Application time of painkiller and hospital stay were shorter in laparoscopy group than in open surgery group （0.7±0.5） d vs. （2.3±0.9） d，（8.7±1.6） d vs. （13.1±3.2） d，P=0.000. Time of getting out of bed was earlier in laparoscopy group than in open surgery group （2.1±0.5） d vs. （4.2±1.0） d，P=0.000. No significant difference was found between two groups in operation time （212.1±19.5） min vs. （251.7±24.2） min and recovery time of intestinal function （1.9±0.8） d vs. （2.9±0.8） d as well as in survival rates，postoperative complications，incidences of bladder carcinoma recurrence and distant metas－tasis during the follow-up period（P >0.05）. Conclusions：With the advantages of minimal invasion，complete retroperitoneal laparo－scopic radical nephroureterectomy conforms to the principles of oncology and should be widely applied as an ideal surgical treatment method for upper urinary tract transitional cell carcinoma.