后腹腔镜治疗上尿路移行细胞癌

目的：比较后腹腔镜肾输尿管全切及膀胱袖状切除术与开放手术治疗上尿路移行细胞癌的临床疗效。方法：回顾分析我院2003年3月至2008年10月行后腹腔镜肾输尿管全切及膀胱袖状切除术治疗上尿路移行细胞癌47例,其中后腹腔镜手术26例（A组）,传统的开放手术21例（B组）。对两组的临床疗效及随访结果等进行对比研究。结果：两组在发病年龄、性别、肿瘤大小、手术时间比较差异无显著性意义;A组术中出血量（98.2±28.5）ml、术后（33.6±12.4）h肠功能恢复、（43.5±12.5）h下床活动、应用止痛药（1.5±0.5）d、静脉应用抗生素（3.5±1.1）d、术后住院天数（6.5±1.5）d、（20.0±8.5）d恢复正常工作,明显优于B组,差异有统计学意义（P＆lt;0.05）;A组并发症少于B组。两组平均随访（36.6±16.0）、（38.0±16.7）月,5年无复发生存率和总生存率比较无显著性差异（P＆gt;0.05）。结论：后腹腔镜肾输尿管切除及膀胱袖状切除术与开放手术相比,疗效相当,创伤小、痛苦少、术后恢复快、并发症少,可作为上尿路移行细胞癌的首选治疗方法。

Comparison of laparoscopic retroperitoneal and open surgery for upper urinary tract transitional cell carcinoma

Objectives： To compare outcome and follow up of laparoscopic retroperitoneal nephroureterectomy with excision of cuff of bladder （LRPNUT-BCE） and open nephroureterectomy with excision of cuff of bladder （ONUT-BCE） in patients of upper urinary tract transitional cell carcinoma （UTTCC）. Methods： From March 2003 to October 2008, we have performed over 47 cases of nephroureterectomy with excision of cuff of bladder for UTTCC. Out of these, patients undergoing LRPNUT-BCE and ONUT-BCE were categorized retrospectively into group A （26）, and group B （21）, respectively. The clinical data and follow-up data was recorded for two groups and analyzed statistically. Results： Age, gender, tumor size were comparable in both groups （LRPNUT-BCE vs ONUT-BCE）. The intraoperative bleeding loss （98.2± 18.5）ml, the mean time to oral intake （33.6± 8.8）h, time to ambulation （43.5± 12.5）h, use of antalgesic （1.5± 0.5）d, intravenous antibiotic （3.5± 1.1）d, length ofpostoprative hospital stay （6.5± 1.2）d, （20.0± 8.5）d convalescene of normal activities and incidence of complications with Group A were significantly superior to those with Group B （P〈0.05）; There were no differences in average operating time （150.2± 13.0 vs 141.7± 17.2min, P =0.059）. Median follow-up was （36.6± 16.0） and （38.0± 16.7） months, there were no differences in the 5-year recurrence free survival and overall survival in two groups. Conclusions： laparoscopic retroperitoneal nephroureterectomy with excision of cuff of bladder （LRPNUT-BCE） can be used initially for upper urinary tract transitional cell carcinoma （UTTCC）, with equivalent oncologie outcomes to open approaches while providing advantages of minimal invasion, less suffering, quicker recovery and less complications.