Total Retroperitoneal Laparoscopic Nephroureterectomy with Bladder-Cuff Resection for Upper Urinary Tract Transitional Cell Carcinoma
Total Retroperitoneal Laparoscopic Nephroureterectomy with Bladder-Cuff Resection for Upper Urinary Tract Transitional Cell Carcinoma
复制标题
全腹膜后腹腔镜肾输尿管切除术联合膀胱套切除术治疗上尿路移行细胞癌
DOI：
10.3109/08941939.2014.930214
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发表时间：
2014-12-01
影响因子：
1.9
通讯作者：
Ye, Gang
中科院分区：
文献类型：
--
作者：
Fang, Zhenqiang;Li, Longkun;Ye, Gang
背景资料：开放性肾输尿管切除术（ONU）和膀胱袖状切除术（ONU-BCR）已成为上尿路移行细胞癌（UUT-TCC）外科治疗的金标准。本研究旨在介绍一种改良的后腹腔镜肾输尿管切除术（LNU）联合膀胱袖状切除术（LNU-BCR）治疗UUT-TCC的方法，并与ONU-BCR的临床疗效进行比较。研究方法：本回顾性研究分析了2008年1月至2012年6月期间接受ONU-BCR（n = 36）或LNU-BCR（n = 29）的65例UUT-TCC患者。比较随访6个月以上患者的围手术期资料以及原发灶复发或远处转移的发生率。结果如下：与ONU-BCR患者相比，LNU-BCR患者的手术时间明显缩短，估计失血量减少，口服时间缩短，镇痛剂量减少，镇痛持续时间缩短，切口引流管持续时间缩短，下床时间缩短，术后住院时间缩短（所有，p <0.05）。术后并发症发生率、膀胱癌复发率、远处转移率均无显著性差异。结论：改良的LNU-BCR是ONU-BCR的一种有效和安全的替代技术，具有减少侵入性、出血和住院的优点。
Background: Open nephroureterectomy (ONU) and bladder cuff resection (ONU-BCR) has been the gold standard of surgical treatment for upper urinary tract transitional cell carcinoma (UUT-TCC). The aim of this study is to introduce a modified total retroperitoneal laparoscopic nephroureterectomy (LNU) with bladder-cuff resection (LNU-BCR) method for treating UUT-TCC and compare its clinical efficacy with ONU-BCR. Methods: Sixty-five patients with UUT-TCC, who underwent ONU-BCR (n = 36) or LNU-BCR (n = 29) between January 2008 and June 2012, were analyzed in this retrospective study. Perioperative data as well as incidence of disease recurrence at the primary site or distant metastasis was compared in patients with at least 6 months follow-up. Results: As compared with patients with ONU-BCR, the patients with LNU-BCR had significantly shorter operative time, lower estimated blood loss, shorter time to oral intake, lower analgesic dose, shorter duration of analgesic use, shorter duration of incision drainage tube, shorter time to ambulation out of bed and reduced postoperative hospital stay (all, p < .05). No significant difference in postoperative complications or incidence of bladder carcinoma recurrence and distant metastasis during the follow-up period was observed. Conclusions: The modified LNU-BCR represents an effective and safe alternative technique to ONU-BCR with the advantages of reduced invasiveness, bleeding and hospitalization.