经腹途径与腹膜后途径下根治性肾输尿管全切术的比较分析

吴岩; 徐新宇; 董坚; 杨春; 冯宁翰

doi:10.13201/j.issn.1001-1420.2020.03.008

经腹途径与腹膜后途径下根治性肾输尿管全切术的比较分析

- 南京医科大学附属无锡第二医院泌尿外科(江苏无锡, 214002)

详细信息

通讯作者: 冯宁翰,E-mail:fnh888@njmu.edu.cn

中图分类号: R737.11

收稿日期: 2018-10-06

Comparison of laparoscopic radical nephroureterectomy by transperitoneal versus extraperitoneal approach

- Department of Urology, Wuxi Second Hospital, Nanjing Medical University, Wuxi, Jiangsu, 214002, China

More Information

Corresponding author: FENG Ninghan, E-mail: fnh888@njmu.edu.cn

Received Date: 06 October 2018

摘要

摘要: 目的:比较经腹途径与腹膜后途径下根治性肾输尿管全切术的疗效及安全性。方法:回顾性分析2013年3月~2016年4月行腹腔镜下根治性肾输尿管全切术患者的临床资料,根据时间顺序分为经腹腹腔镜根治性肾输尿管全切术(TLNU)18例和腹膜后腹腔镜下根治性肾输尿管全切术(RLNU)17例,收集统计所有患者的一般临床资料及围手术期资料。结果:两组手术均顺利完成,无中转开放者。TLNU组和RLNU组在患者年龄、性别、BMI、肿瘤患侧及肿瘤位置等方面比较差异均无统计学意义(P>0.05)。两组的肠道功能恢复时间分别为(2.8±1.7) d和(2.0±1.4) d,术后住院时间分别为(6.7±2.1) d和(5.6±1.8) d,差异均有统计学意义(P<0.05)。两组的手术时间[(118.2±24.3) min vs.(109.3±31.8) min]、手术估计出血量[(125.6±45.2)mL vs.(111.9±43.6) mL]、引流管拔除时间[(3.5±1.9) d vs.(3.6±2.0)d]、导尿管拔除时间[(6.9±2.8) d vs.(7.2±3.1) d]比较差异无统计学意义(P>0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论:经腹和腹膜后腹腔镜途径治疗上尿路尿路上皮癌是安全、有效的。相对于经腹途径,腹膜后途径有着更短的术后肠功能恢复时间及住院时间。
- 腹腔镜 /
- 上尿路尿路细胞癌 /
- 根治性肾输尿管全切术
Abstract: Objective: To compare the safety and oncological results of laparoscopic radical nephroureterectomy performed between transperitoneal and extraperitoneal approach. Method: Selected patients who underwent laparoscopic radical nephroureterectomy were divided into two groups: the transperitoneal group(18 patients) and retroperitoneal group(17 patients). Result: All procedures were performed successfully without conversion. There was no difference between two groups in terms of age, sex, BMI, tumor side or tumor location. Time to first oral take of transperitoneal group was longer than that of retroperitoneal group[(2.8±1.7) d vs.(2.0±1.4) d, P<0.05]. Postoperative hospital stay oftransperitoneal group was longer than that of retroperitoneal group[(6.7±2.1) d vs.(5.6±1.8) d, P<0.05].No significant difference was found between two groups in the terms of procedure time, estimated blood loss, duration of incision drainage tube, duration of catheterizationor complications(P>0.05).Conclusion: Both transperitoneal and retroperitoneal laparoscopicradical nephroureterectomy are safe and effective. However, the retroperitoneal approach can provide fastergastrointestinal function recovery and shorter postoperative hospital stay.
- laparoscope /
- upper urinarytract urothelial carcinoma /
- radical nephroureterectomy

HTML全文

参考文献(13)

[1]	Siegel R,Naishadham D,Jemal A.Cancer statistics,2012[J].CA Cancer J Clin,2012,62:10-29.
[2]	Clayman RV,Kavoussi LR,Figenshau RS,et al.Laparoscopic nephroureterectomy:initial clinical case report[J].J Laparoendosc Surg,1991,1(6):343-349.
[3]	Wang J,Yu S,Men C,et al.Transurethral Electric Coagulation Combined With Retroperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Urothelial Carcinoma[J].Int Surg,2015,100(3):547-551.
[4]	Ye J,Ma L,Huang Y,et al.Retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for native upper tract transitional cell carcinoma ipsilateral to a transplanted kidney[J].Urology,2010,76(6):1395-1399.
[5]	胡明球,李宁忱,张志宏,等.保留肾脏手术治疗原发性输尿管癌的临床疗效分析[J].临床泌尿外科杂志,2017,32(11):60-62,68.
[6]	Yuan B,Wang Y,Gao J,et al.Lower pole approach in retroperitoneal laparoscopic radical nephrectomy:a new approach for the management of renal vascular pedicle[J].World J Surg Oncol,2018,16(1):31.
[7]	Fan X,Xu K,Lin T,et al.Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma:a systematic review and meta-analysis[J].BJU Int,2013,111(4):611.
[8]	张亚群,付春龙,朱生才,等.经腹腔完全腔镜下肾输尿管膀胱袖状切除术中输尿管末段处理的经验总结[J].临床泌尿外科杂志,2019,34(3):39-42.
[9]	Liu W,Wang Y,Zhong Z,et al.Transperitoneal versus retroperitoneal laparoscopic nephroureterectomy in the management of upper urinary tract urothelial carcinoma:a matched-pair comparison based on perioperative outcomes[J].Surg Endosc,2016,30(12):5537-5541.
[10]	Nigri G,Rosman AS,Petrucciani N.Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy[J].Surgery,2013,153(1):111-119.
[11]	陈湘,陈星星,李勇,等.完全后腹腔镜下肾盂输尿管癌根治性切除术[J].中国内镜杂志,2006,12(6):572-574.
[12]	Liu JY,Dai YB,Zhou FJ,et al.Laparoscopic versus open nephroureterectomy to treat localized and/or locally advanced upper tract urothelial carcinoma:oncological outcomes from a multicenter study[J].BMC Surg,2017,17(1):8.
[13]	Zigeuner R,Pummer K.Urothelial carcinoma of the upper urinary tract:surgical approach and prognostic factors[J].Eur Urol,2008,53(4):720-731.