机器人辅助腹腔镜根治性肾输尿管切除术治疗非转移性高危上尿路尿路上皮癌的疗效分析

Efficacy analysis of robot-assisted radical nephroureterectomy and laparoscopic radical nephroureterectomy for non-metastatic high-risk upper tract urothelial carcinoma

摘要:

目的：研究机器人辅助腹腔镜根治性肾输尿管切除术（robot-assisted radical nephroureterectomy，RRNU）与腹腔镜根治性肾输尿管切除术（laparoscopic radical nephroureterectomy，LRNU）治疗非转移性高危上尿路尿路上皮癌（upper tract urothelial carcinoma，UTUC）患者的临床效果。方法：回顾性研究本中心2018年1月至2020年12月，70例接受根治性肾输尿管切除术的非转移性高危UTUC患者，RRNU组19例，LRNU组51例。对围手术期结果及肿瘤学预后指标进行分析。结果：术中均无大血管损伤等严重并发症致患者死亡的情况。2组复发情况无统计学差异（P>0.05）。术后住院时间（d）[5（4，6） vs. 6（5，8），Z=2.076，P=0.038]、术后引流量（mL）[75（20，186） vs. 160（90，245），Z=2.411，P=0.016]、引流管保留时间（d）[2（3，4） vs. 3（4，5），Z=2.276，P=0.023]和费用（万元）[8.33（7.51，8.78） vs. 3.91（3.46，4.94），Z=6.319，P=0.000]有统计学差异。术中出血量、手术时间等无统计学差异（P>0.05）。结论：RRNU与LRNU在治疗非转移性高危UTUC的短期复发情况没有明显差异。RRNU具有缩短术后住院时间、减少术后引流量及引流管保留时间、加速患者康复等优势，但是费用更贵。

Abstract:

Objective：To investigate the clinical efficacy of robot-assisted radical nephroureterectomy（RRNU） for patients with non-metastatic high-risk upper tract urothelial carcinoma（UTUC） compared with laparoscopic nephroureterectomy（LRNU）. Methods：We retrospectively analyzed 70 cases of non-metastatic high-risk UTUC treated by radical nephroureterectomy from January 2018 to December 2020，including 19 cases of RRNU and 51 cases of LRNU. The perioperative outcomes and oncology prognosis were ana－lyzed. Results：There was no death caused by major vascular injury and other serious complications. There were no significant differ－ences in recurrence between the two groups（P >0.05）. There were statistically significant differences in postoperative hospital stay（d）[5（4，6） vs. 6（5，8），Z=2.076，P=0.038]，postoperative drainage volume（mL）[75（20，186） vs. 160（90，245），Z=2.411，P=0.016]，drainage tube retention time（d）[2（3，4） vs. 3（4，5），Z=2.276，P=0.023] and cost（ten thousand yuan）[8.33（7.51，8.78）vs. 3.91（3.46，4.94），Z=6.319，P=0.000]. There were no significant differences in intraoperative blood loss and operation time（P >0.05）. Conclusion：There are no significant differences in recurrence between RRNU and LRNU in the treatment of non-metastatic high-risk UTUC. RRNU has the advantages of shortening postoperative hospital stay，reducing postoperative drainage and drainage tube retention time，and accelerating the recovery of patients，but the cost of RRNU is more expensive.