后腹腔镜联合经尿道电切与下腹斜切口治疗上尿路尿路上皮癌的对照研究

廖德洋; 周晓洲; 付坚; 刘洋; 李珍燕; 王永权; 周占松

doi:10.16016/j.1000-5404.202010083

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后腹腔镜联合经尿道电切与下腹斜切口治疗上尿路尿路上皮癌的对照研究

临床医学 | 更新时间：2026-01-09

- 后腹腔镜联合经尿道电切与下腹斜切口治疗上尿路尿路上皮癌的对照研究
- Transurethral ureteral orifice resection versus open resection after retroperitoneal laparoscopic nephroureterectomy for upper urinary urothelial carcinoma: a clinical control study of 59 cases
- 第三军医大学学报 2021年43卷第8期页码：761-765
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院泌尿外科
- 作者简介：
  
  [周占松，E-mail: zhouzhansong@sohu.com ZHOU Zhansong, E-mail: zhouzhansong@sohu.com
- 基金信息：
  
  陆军军医大学临床医学科研人才培养计划(2018XLC3006)
- DOI：10.16016/j.1000-5404.202010083
  中图分类号： R730.56;R737.11;R737.13
- 收稿：2020-10-15，
  
  修回：2021-01-07，
  
  纸质出版：2021-04-30
- 稿件说明：
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廖德洋, 周晓洲, 付坚, 等. 后腹腔镜联合经尿道电切与下腹斜切口治疗上尿路尿路上皮癌的对照研究[J]. 第三军医大学学报, 2021,43(8):761-765.

Deyang LIAO, Xiaozhou ZHOU, Jian FU, et al. Transurethral ureteral orifice resection versus open resection after retroperitoneal laparoscopic nephroureterectomy for upper urinary urothelial carcinoma: a clinical control study of 59 cases[J]. Journal of Third Military Medical University, 2021, 43(8): 761-765.
廖德洋, 周晓洲, 付坚, 等. 后腹腔镜联合经尿道电切与下腹斜切口治疗上尿路尿路上皮癌的对照研究[J]. 第三军医大学学报, 2021,43(8):761-765. DOI： 10.16016/j.1000-5404.202010083.

Deyang LIAO, Xiaozhou ZHOU, Jian FU, et al. Transurethral ureteral orifice resection versus open resection after retroperitoneal laparoscopic nephroureterectomy for upper urinary urothelial carcinoma: a clinical control study of 59 cases[J]. Journal of Third Military Medical University, 2021, 43(8): 761-765. DOI： 10.16016/j.1000-5404.202010083.

摘要

目的

探讨后腹腔镜联合经尿道输尿管口电切治疗上尿路尿路上皮癌(upper urinary tract urothelial carcinoma，UTUC)的安全性与有效性。

方法

收集2016年7月至2019年7月本院采用后腹腔镜联合下腹部斜切口(下腹切口组)或后腹腔镜联合经尿道输尿管口电切(电切组)治疗UTUC患者的临床资料。其中下腹部切口组39例，电切组20例，共59例。比较两组手术时间、术中出血量、肠道功能恢复时间、留置引流时间、术后住院时间、术后并发症及1年复发转移率等指标。

结果

电切组手术时间长于下腹切口组，差异有统计学意义(219.1±54.2

178.7±60.8 min，

＜0.05)。电切组留置引流时间、肠道功能恢复时间、术后住院时间均较下腹切口组显著缩短(

＜0.05)。下腹切口组术后并发症共4例，其中肺部感染2例，腹膜后积液1例，术区淋巴漏1例；电切组术后出现膀胱出血1例，行二次膀胱电切镜止血。两组其余指标比较无明显差异。

结论

后腹腔镜联合经尿道输尿管口电切治疗上尿路尿路上皮癌是安全、有效的。相对于后腹腔镜联合下腹部斜切口术式，具有创伤小，恢复快的优势。

Abstract

Objective

To evaluate the safety and effectiveness of retroperitoneal laparoscopic nephroureterectomy combined with transurethral resection of the ureteral orifice for the treatment of upper urinary urothelial carcinoma (UTUC).

Methods

We retrospectively analyzed the clinical data of 59 UTUC cases treated in our hospital from July 2013 to July 2019

who underwent retroperitoneal laparoscopic nephroureterectomy combined with transurethral resection of the ureteral orifice (

=20) or abdominal incision(

=39). Blood loss volume

time of incision drainage

recovery time of postoperative intestinal function

postoperative hospitalization time

postoperative complications and local recurrence

and distant metastasis were compared between the 2 groups.

Results

The transurethral resection group had significantly longer operative time (219.1±54.2

178.7±60.8 min

0.05)

but shorter time of incision drainage

recovery time of postoperative intestinal function and postoperative hospitalization time (

0.05) when compared with the abdominal incision group. There were 4 cases having operative complications in the abdominal incision group

including 2 cases of pulmonary infection

1 case of retroperitoneal effusion

and 1 case of lymphorrhagia. In the transurethral resection group

there was 1 case of postop

erative bladder bleeding

and cystoscopic electrocision was performed for hemostasis. No significant differences were found in other evaluated indicators between the 2 groups.

Conclusion

Retroperitoneal laparoscopic nephroureterectomy combined with resection of the ureteral orifice is safe and effective for the treatment of UTUC. Compared with abdominal incision

transurethral approach has the advantage of less trauma and rapider recovery.

关键词

Keywords

references

MARGULIS V, SHARIAT S F , MATIN S F, et al . Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration[J ] . Cancer, 2009, 115(6): 1224-1233. DOI: 10.1002/cncr.24135.

WALTON T J, NOVARA G, MATSUMOTO K, et al . Oncological outcomes after laparoscopic and open radical nephroureterectomy: results from an international cohort[J ] . BJU Int, 2011, 108(3): 406-412. DOI: 10.1111/j.1464-410x.2010.09826.x.

陈长金, 邹晓峰, 张国玺. 高危上尿路尿路上皮癌的外科治疗进展[J]. 赣南医学院学报, 2020, 40(5): 527-531. DOI: 10.3969/j.issn.1001-5779.2020.05.023.

CHEN C J, ZOU X F, ZHANG G X. Surgical treatment of high-risk upper urinary tract urothelial carcinoma[J]. J Gannan Med Univ, 2020, 40(5): 527-531. DOI: 10.3969/j.issn.1001-5779.2020.05.023.

吕东, 窦科, 向颖, 等. 经腹腔与经后腹腔途径行腹腔镜上尿路尿路上皮癌根治性切除术的疗效比较[J]. 临床泌尿外科杂志, 2016, 31(11): 979-981. DOI: 10.13201/j.issn.1001-1420.2016.11.005.

LYU D, DOU K, XIANG Y, et al . Comparison of efficacy between transperitoneal and retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma[J ] . J Clin Urol, 2016, 31(11): 979-981. DOI: 10.13201/j.issn.1001-1420.2016.11.005.

ATTALLA K, PATNAIK S, VELLOS T, et al . Management of distal ureter and bladder cuff at the time of nephroureterectomy: surgical techniques and predictors of outcome[J ] . Future Oncol, 2019, 15(20): 2385-2393. DOI: 10.2217/fon-2019-0064.

CLAYMAN R V, KAVOUSSI L R, FIGENSHAU R S, et al . Laparoscopic nephroureterectomy: initial clinical case report[J ] . J Laparo endosc Surg, 1991, 1(6): 343-349. DOI: 10.1089/lps.1991.1.343.

LIU F, GUO W, ZHOU X, et al . Laparoscopic versus open nephroureterectomy for upper urinary tract urothelial carcinoma: A systematic review and meta-analysis[J ] . Medicine (Baltimore), 2018, 97(35): e11954. DOI: 10.1097/MD.0000000000011954.

刘康, 周克冲, 宋宇轩, 等. 比较腹腔镜与开放手术治疗上尿路尿路上皮癌预后的Meta分析[J]. 临床泌尿外科杂志, 2019, 34(2): 113-118. DOI: 10.13201/j.issn.1001-1420.2019.02.007.

LIU K, ZHOU K C, SONG Y X, et al . Oncological outcomes of laparoscopic nephroureterectomy versus open nephroureterectomy for upper tract urothelial carcinoma: meta-analysis[J ] . J Clin Urol, 2019, 34(2): 113-118. DOI: 10.13201/j.issn.1001-1420.2019.02.007.

XYLINAS E, KLUTH L, PASSONI N, et al . Prediction of intravesical recurrence after radical nephroureterectomy: development of a clinical decision-making tool[J ] . Eur Urol, 2014, 65(3): 650-658. DOI: 10.1016/j.eururo.2013.09.003.

HWANG E C, SATHIANATHEN N J, JUNG J H, et al . Single-dose intravesical chemotherapy after nephroureterectomy for upper tract urothelial carcinoma[J ] . Cochrane Database Syst Rev, 2019, 5(5): CD13160. DOI: 10.1002/14651858.CD013160.pub2.

HUANG Y, CEN J, LIU Z, et al . A comparison of different prophylactic intravesical chemotherapy regimens for bladder cancer recurrence after nephroureterectomy for primary upper tract urothelial carcinomas: a retrospective 2-center study[J ] . Technol Cancer Res Treat, 2019, 18: 1533033819844483. DOI: 10.1177/1533033819844483.

FANG D, LI X S, XIONG G Y, et al . Prophylactic intravesical chemotherapy to prevent bladder tumors after nephroureterectomy for primary upper urinary tract urothelial carcinomas: a systematic review and meta-analysis[J ] . Urol Int, 2013, 91(3): 291-296. DOI: 10.1159/000350508.

郑铎, 尚攀峰, 刘隽垚, 等. 上尿路尿路上皮癌患者根治性肾输尿管切除术后膀胱内复发危险因素的Meta分析[J]. 中国循证医学杂志, 2018, 18(3): 305-313. DOI:10.7507/1672-2531.201710121.

ZHENG D, SHANG P F, LIU J Y, et al . Risk factors for intravesical recurrence after radical nephroureterectomy of upper tract urothelial carcinoma: a meta-analysis[J ] . Chin J Evid-Based Med, 2018, 18(3): 305-313. DOI:10.7507/1672-2531.201710121.

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. DOI: 10.1016/j.eururo.2014.11.035.

LEE S M, MCKAY A, GRIMESN, et al . Distal ureter management during nephroureterectomy: evidence from a systematic review and cumulative analysis[J ] . J Endourol, 2019, 33(4): 263-273. DOI: 10.1089/end.2018.0819.

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