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目的:探讨上尿路尿路上皮癌行后腹腔镜下肾输尿管切除术的临床效果。方法:回顾性分析2003年1月~2012年3月因上尿路尿路上皮癌行后腹腔镜下肾输尿管切除术的103例患者的临床资料,其中后腹腔镜联合腹部小切口肾输尿管切除术94例,后腹腔镜联合经尿道膀胱输尿管开口电切9例。结果:103例手术均获成功,无术中转开放手术。平均手术时间(165±52)min,术中平均出血量(125±53)ml,术后平均住院时间(6.4±4.1)d。术中术后未发生严重并发症。术后病理诊断均为尿路上皮癌,Ta10例,T143例,T227例,T323例。术后平均随访55(6~90)个月,17例术后发生膀胱肿瘤,4例术后发生肺部转移,7例患者死亡,其中4例发生肺部转移者均于术后2年死亡。结论:后腹腔镜下肾输尿管切除术具有术程短、出血少、创伤小、恢复快等优点,术后近期疗效好,远期疗效需要进一步评价。
Objective: To investigate the clinical effect of retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma. Methods: The clinical data of 103 patients with retroperitoneal laparoscopic nephroureterectomy for urothelial carcinoma of the upper urinary tract from January 2003 to March 2012 were retrospectively analyzed. Among them, retroperitoneal laparoscopy combined with small incision nephroureterectomy Surgery in 94 cases, retroperitoneal laparoscopic transurethral ureter open resection in 9 cases. Results: All the 103 surgeries were successful. No surgery was performed. The mean operation time was (165 ± 52) min, mean intraoperative blood loss was (125 ± 53) ml, average postoperative hospital stay was (6.4 ± 4.1) days. No serious postoperative complications occurred. Postoperative pathological diagnosis of urothelial carcinoma, Ta10 cases, T143 cases, T227 cases, T323 cases. After an average follow-up of 55 months (range, 6 to 90 months), 17 had postoperative bladder tumor, 4 had lung metastasis after operation, and 7 had died. Four of the 4 patients who had lung metastases died after 2 years . Conclusions: Retroperitoneal laparoscopic nephroureterectomy has the advantages of short course, less bleeding, less trauma and faster recovery. The short-term effect is good and the long-term curative effect needs further evaluation.