Laparoscopic versus Open Nephroureterectomy: Perioperative and Oncologic Outcomes from a Randomised Prospective Study
Laparoscopic versus Open Nephroureterectomy: Perioperative and Oncologic Outcomes from a Randomised Prospective Study
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DOI：
10.1016/j.eururo.2009.06.013
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发表时间：
2009-09-01
期刊：
影响因子：
23.4
通讯作者：
Gallucci, Michele
中科院分区：
文献类型：
--
作者：
Simone, Giuseppe;Papalia, Rocco;Gallucci, Michele
背景：腹腔镜肾输尿管切除术(LNU)正逐渐取代开腹肾输尿管切除术(ONU)用于上尿路尿路上皮癌(UUT)的治疗，但同样有效的肿瘤学疗效的证据仍然缺乏。目的：介绍一项比较ONU和LNU的前瞻性随机研究的围手术期和肿瘤学结果。设计、背景和对象：80例无上尿路尿路上皮癌病史的非转移性UT UC患者。其中40例(A组)随机接受ONU治疗，40例(B组)随机接受LNU治疗。使用四针技术进行经腹膜LNU，并使用10 mm LigaSure装置分离膀胱袖。测量：将围手术期数据与学生t检验进行比较。两组患者的膀胱无瘤生存期(BTFS)、无转移生存期(MFS)和肿瘤特异性生存期(CSS)曲线在分组前后采用对数等级检验进行比较。结果和限制：B组手术时间相似，而平均出血量和平均出院时间显著低于B组(均p<0.05
Background: Laparoscopic nephroureterectomy (LNU) is increasingly being used instead of open nephroureterectomy (ONU) for the treatment of urothelial carcinoma (UC) of the upper urinary tract (UUT), but the evidence of equal oncologic effectiveness is still lacking.Objective: To present perioperative and oncologic results from a prospective randomised study comparing ONU and LNU.Design, setting, and participants: Eighty patients with nonmetastatic UUT UC and without previous history of UC were enrolled. Of those, 40 patients (group A) randomly received ONU and 40 patients (group B) randomly received LNU.Interventions: ONU was performed through a flank incision with a lower quadrant incision to allow excision of a bladder cuff. Transperitoneal LNU was performed with a four-trocar technique, and bladder cuff was detached with a 10-mm LigaSure device.Measurements: Perioperative data were compared with the student t test. Bladder tumour-free survival (BTFS), metastasis-free survival (MFS), and cancer-specific survival (CSS) curves for both groups were compared with the log-rank test before and after stratifying patients for pT category and turnout grade.Results and limitations: Operative times were comparable, while mean blood loss and mean time to discharge were significantly lower in group B (both p values