Laparoscopic nephroureterectomy for the treatment of transitional cell carcinoma of the upper urinary tract
Laparoscopic nephroureterectomy for the treatment of transitional cell carcinoma of the upper urinary tract
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DOI：
10.1016/s0090-4295(00)01043-8
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发表时间：
2001-03-01
期刊：
影响因子：
2.1
通讯作者：
Kavoussi, LR
中科院分区：
文献类型：
--
作者：
Jarrett, TW;Chan, DY;Kavoussi, LR
目标。目的探讨腹腔镜和腹腔镜辅助肾输尿管切除术的安全性和有效性。自1993年以来，25例患者至少随访12个月，采用全腹腔镜或腹腔镜辅助技术行肾输尿管切除术。4名患者进行了标本粉碎以去除组织。根据肿瘤的转移潜能，所有患者定期进行体格检查、间歇性膀胱镜检查和X光检查。对手术时间、出血量、肿瘤病理分期、并发症和预后进行了回顾和评估。1例患者因多次腹部手术后中转开放而被排除在外。平均手术时间为329分钟，但随经验的增加而缩短。中位住院天数为4天。肿瘤分期与肿瘤分级直接相关。相关的膀胱肿瘤(既往病史或复发肿瘤)在50%的患者中发生。1例发生同侧输尿管残端复发。虽然没有发生端口种植，但1例患者在腹腔镜肾盂成形术后被组织学发现为良性疾病，出现肾窝复发和转移性疾病。结论全腹腔镜和腹腔镜辅助肾输尿管切除术是治疗上尿路移行细胞癌的一种可以接受的手术替代方法。肿瘤粉碎似乎不会对患者的预后产生不利影响。与开腹肾输尿管切除术一样，肿瘤分级是判断局部、膀胱和转移性复发的最重要的预后指标。无论是完全腹腔镜组还是辅助腹腔镜组均未观察到孔口种植。泌尿外科57：448-453,2001。(C)2001年，爱思唯尔科学公司。
Objectives. To establish the safety and efficacy of laparoscopic and laparoscopic-assisted nephroureterectomy.Methods. Since 1993, 25 patients with a minimum of 12 months of follow-up underwent nephroureterectomy using a total laparoscopic or laparoscopic-assisted technique. Four patients had specimen morcellation for tissue removal. All patients had regular follow-up with physical examinations, interval cystoscopy, and radiographs, depending on the metastatic potential of the tumor. Retrospective chart review was performed and assessed for operative time, blood loss, tumor pathologic stage, complications, and outcome. One patient was excluded because of an open conversion due to multiple previous abdominal surgeries and failure to progress.Results. The mean operating time was 329 minutes but decreased with experience. The median hospital stay was 4 days. Tumor stage was directly related to tumor grade. Associated bladder tumors (prior history or recurrent tumors) occurred in 50% of the patients. Ipsilateral ureteral stump site recurrence occurred in 1 patient. Although no port site seeding occurred, 1 patient, whose tumor was discovered histologically after laparoscopic pyeloplasty for presumed benign disease, developed recurrence in the renal fossa and metastatic disease. Two patients developed liver metastasis.Conclusions, Total laparoscopic and laparoscopic-assisted nephroureterectomy are acceptable alternatives to open surgery in the treatment of transitional cell carcinoma of the upper urinary tract. Tumor morcellation did not appear to adversely affect patient outcome. As with open nephroureterectomy, tumor grade is the most important prognostic indicator of local, bladder, and metastatic recurrence. No port site seeding was observed in either the total laparoscopic or laparoscopic-assisted groups. UROLOGY 57: 448-453, 2001. (C) 2001, Elsevier Science Inc.