Clinical application of modified transperitoneal laparoscopic nephroureterectomy with a single body position
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摘要: 目的 探讨完全经腹腹腔镜一体位肾输尿管全长切除以及输尿管末端使用定制的防滑哈巴狗钳切除的手术方法和临床价值。方法 回顾性分析2018年2月—2021年3月在汉中市中心医院接受经腹腹腔镜一体位肾输尿管全长切除术的16例上尿路尿路上皮癌患者的临床资料。改良腹腔镜手术方式，术中患者无须改换体位，改良手术器械，用特制防滑哈巴狗钳夹闭膀胱袖口状切除，将膀胱切口用1-0可吸收线连续缝合。结果 本组病例均手术顺利，手术时间130~290 min，平均(187.5±37.7)min；术中失血量30~180 mL，平均(83.1±40.6)mL。术后病理诊断均为尿路上皮癌，低级别5例，高级别11例。所有患者随访1~27个月，均无瘤生存。结论 改良全腹腔镜一体位肾输尿管全长切除术更加符合肿瘤根治原则，具有手术步骤简洁、安全有效、恢复快、减少并发症的优点，具有推广应用价值。Abstract: Objective To evaluate the operative method and clinical value of complete transperitoneal laparoscopic nephroureterectomy and distal ureter resection using a custom-made antislip laparoscopic bulldog clamp.Methods From February 2018 to March 2021, we retrospectively analyzed 16 patients with upper tract urothelial carcinoma who underwent complete transperitoneal laparoscopic nephroureterectomy in Hanzhong Central Hospital. The modified surgical method and instrument includes the bladder cuff resection with a special large clamp and suturing the bladder incision by running closure using 1-0 absorbable suture without repositioning the patient during the operation.Results The operations were all successful in 16 cases. The mean operative time was (187.5±37.7) min, ranging from 130 to 290 minutes, and the intraoperative blood loss was (83.1±40.6) mL, ranging from 30 to 180 mL. Pathological results showed urothelial carcinoma in all cases, including 5 cases of low grade and 11 cases of high grade. All patients who were followed up for 1 to 27 months survived free of tumor.Conclusion Modified complete transperitoneal laparoscopic nephroureterectomy is more in line with the principle of cancer radical cure. It has the advantages of simple procedure, safety and effectiveness, rapid recovery and less complications. It is worthy of spread and application.
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[1] Rouprêt M, Babjuk M, Burger M, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update[J]. Eur Urol, 2021, 79(1): 62-79.
[2] Siegel RL, Miller KD, Fuchs HE, et al. Cancer Statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1): 7-33. doi: 10.3322/caac.21654
[3] 中国医师协会泌尿外科医师分会肿瘤专业委员会, 中国医师协会泌尿外科医师分会上尿路尿路上皮癌(CUDA-UTUC)协作组. 上尿路尿路上皮癌诊断与治疗中国专家共识[J]. 中华泌尿外科杂志, 2018, 39(7): 485-488. doi: 10.3760/cma.j.issn.1000-6702.2018.07.002
[4] 陈金虎, 方卫华, 梁朝朝. 上尿路尿路上皮癌临床治疗进展[J]. 临床泌尿外科杂志, 2021, 36(5): 415-420. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=a045d197-9bac-45c6-8d97-3b50abc9a702
[5] Kanno T, Kobori G, Kubota M, et al. Standardized and Simplified Retroperitoneal Lymph Node Dissection During Retroperitoneal Laparoscopic Radical Nephroureterectomy for Urothelial Carcinoma of the Upper Ureter or Renal Pelvis: En Bloc Resection Technique[J]. Urology, 2018, 112(1): 85-91.
[6] Lin VC, Chen CH, Chiu AW. Laparoscopic nephroureterectomy for upper tract urothelial carcinoma-Update[J]. Asian J Urol, 2016, 3(3): 115-119. doi: 10.1016/j.ajur.2016.05.003
[7] van Doeveren T, van de Werken H, van Riet J, et al. Synchronous and metachronous urothelial carcinoma of the upper urinary tract and the bladder: Are they clonally related? A systematic review[J]. Urol Oncol, 2020, 38(6): 590-598. doi: 10.1016/j.urolonc.2020.01.008
[8] Seisen T, Granger B, Colin P, et al. A Systematic Review and Meta-analysis of Clinicopathologic Factors Linked to Intravesical Recurrence After Radical Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma[J]. Eur Urol, 2015, 67(6): 1122-1133.
[9] 袁易初, 黄吉炜, 蔡文, 等. 非肌层浸润性膀胱癌病史或合并非肌层浸润性膀胱癌对行根治手术的上尿路尿路上皮癌患者预后的影响——上海仁济医院10年资料总结[J]. 临床泌尿外科杂志, 2019, 34(2): 104-108, 112. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=c27fd642-bd5f-400f-bc71-1a663cce2fe4
[10] Kuroiwa K, Inokuchi J, Nishiyama H, et al. Impact of Previous, Simultaneous or Subsequent Bladder Cancer on Prognosis after Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma[J]. J Urol, 2019, 202(6): 1127-1135. doi: 10.1097/JU.0000000000000422
[11] Agarwal DK. Agarwal PolyLoop Ligation Technique for the Management of the Distal Ureter during Laparoscopic Assisted Nephroureterectomy[J]. Curr Urol, 2020, 13(4): 209-213. doi: 10.1159/000499270
[12] Xylinas E, Rink M, Cha EK, et al. Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma[J]. Eur Urol, 2014, 65(1): 210-217. doi: 10.1016/j.eururo.2012.04.052
[13] 吴岩, 徐新宇, 董坚, 等. 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[J]. 临床泌尿外科杂志, 2020, 35(3): 201-204. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=6fa35b7f-40b7-41e9-aa77-62120a7381e6
[14] 黄涛, 刘义迅, 徐从云, 等. 改良体位经腹完全腹腔镜肾输尿管全长切除术20例报告[J]. 临床泌尿外科杂志, 2020, 35(3): 205-209. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=cb34de63-1bf1-4048-adca-eb7d37924950
[15] Klingler HC, Lodde M, Pycha A, et al. Modified laparoscopic nephroureterectomy for treatment of upper urinary tract transitional cell cancer is not associated with an increased risk of tumour recurrence[J]. Eur Urol, 2003, 44(4): 442-447. doi: 10.1016/S0302-2838(03)00314-2
[16] 徐海, 于芹超, 王艺臻. 上尿路尿路上皮癌输尿管末端处理方式的研究进展[J]. 临床泌尿外科杂志, 2018, 33(6): 494-496, 501. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=211660ec-339d-430a-901e-b4afc426b0d1
[17] Bragayrac L, Machuca V, Saenz E, et al. Transvesical Laparoendoscopic Single-Site Management of Distal Ureter During Laparoscopic Radical Nephroureterectomy[J]. J Endourol, 2021, 35(5): 745-748. doi: 10.1089/end.2014.0071
[18] 后森林, 侯俊清, 张建华, 等. 上尿路尿路上皮癌治疗方式的选择[J]. 临床泌尿外科杂志, 2021, 36(6): 496-501. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=e7866d74-79e0-46e1-bb2b-9ca718aea0fb
[19] 周利群, 张雷. 上尿路尿路上皮癌临床诊疗关键及争议问题[J]. 中华泌尿外科杂志, 2017, 38(12): 881-884. doi: 10.3760/cma.j.issn.1000-6702.2017.12.001
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