中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
5期
347-350
,共4页
龚宇%杜传军%陈继民%罗尉%白福鼎
龔宇%杜傳軍%陳繼民%囉尉%白福鼎
공우%두전군%진계민%라위%백복정
尿路上皮癌%肾输尿管切除术%钬%激光手术
尿路上皮癌%腎輸尿管切除術%鈥%激光手術
뇨로상피암%신수뇨관절제술%화%격광수술
Urothelial carcinoma%Nephroureterectomy%Holmium%Laser surgery
目的 评估钬激光、电切及开放手术在上尿路上皮性恶性肿瘤根治术中袖套状切除膀胱-输尿管下段的临床疗效. 方法 回顾性分析2000年1月至2010年12月162例肾盂癌、中上段输尿管癌患者的资料.肾及近端输尿管切除术采用开放或后腹腔镜法.袖套状切除膀胱-输尿管下段分别采用钬激光(A组)32例、电切(B组)51例及开放手术(C组)79例.经尿道手术组术中插入5F输尿管气囊导管以阻断尿流.病理诊断均为肾盂和(或)输尿管上皮癌,病理分期为T(4)NoM0 ～T4N0M0.对3组围手术期指标(手术时间、术中失血量、术中并发症、术后住院时间等)和术后随访结果(肿瘤复发率、肿瘤种植发生率、患者生存率等)进行对照研究.术后随访3个月～8年. 结果 A、B组手术时间[(203.6±31.5),(207.2±24.3) min]、术中失血量[(127.4±63.2),(135.0±82.7) ml]、术后住院时间[(5.8±1.3),(5.6±1.2)d]显著低于C组[(248.0±42.9) min,( 484.5±217.7)ml,(8.7±3.5)d,P＜0.01].B组术中发生闭孔神经反射6例,膀胱穿孔合并较大出血3例,其中中转开放手术2例.3组术后膀胱肿瘤发生率(16.3％、18.1％、21.7％)、肿瘤种植发生率(均为0)、1、3年生存率(96.3％/90.5％、98.0％/88.6％、95.7％/86.4％)比较差异均无统计学意义(P＞0.05). 结论 经尿道术式的创伤程度、手术时间、术中失血量、术后恢复时间等围手术期指标显著优于传统开放手术,膀胱肿瘤发生率、肿瘤种植发生率、生存率等与开放手术相当.袖套状切除膀胱-输尿管下段的手术方式与术后肿瘤复发率无关.钬激光袖套状切除膀胱-输尿管下段是肾盂癌和输尿管癌根治术中安全、微创的方法.
目的 評估鈥激光、電切及開放手術在上尿路上皮性噁性腫瘤根治術中袖套狀切除膀胱-輸尿管下段的臨床療效. 方法 迴顧性分析2000年1月至2010年12月162例腎盂癌、中上段輸尿管癌患者的資料.腎及近耑輸尿管切除術採用開放或後腹腔鏡法.袖套狀切除膀胱-輸尿管下段分彆採用鈥激光(A組)32例、電切(B組)51例及開放手術(C組)79例.經尿道手術組術中插入5F輸尿管氣囊導管以阻斷尿流.病理診斷均為腎盂和(或)輸尿管上皮癌,病理分期為T(4)NoM0 ～T4N0M0.對3組圍手術期指標(手術時間、術中失血量、術中併髮癥、術後住院時間等)和術後隨訪結果(腫瘤複髮率、腫瘤種植髮生率、患者生存率等)進行對照研究.術後隨訪3箇月～8年. 結果 A、B組手術時間[(203.6±31.5),(207.2±24.3) min]、術中失血量[(127.4±63.2),(135.0±82.7) ml]、術後住院時間[(5.8±1.3),(5.6±1.2)d]顯著低于C組[(248.0±42.9) min,( 484.5±217.7)ml,(8.7±3.5)d,P＜0.01].B組術中髮生閉孔神經反射6例,膀胱穿孔閤併較大齣血3例,其中中轉開放手術2例.3組術後膀胱腫瘤髮生率(16.3％、18.1％、21.7％)、腫瘤種植髮生率(均為0)、1、3年生存率(96.3％/90.5％、98.0％/88.6％、95.7％/86.4％)比較差異均無統計學意義(P＞0.05). 結論 經尿道術式的創傷程度、手術時間、術中失血量、術後恢複時間等圍手術期指標顯著優于傳統開放手術,膀胱腫瘤髮生率、腫瘤種植髮生率、生存率等與開放手術相噹.袖套狀切除膀胱-輸尿管下段的手術方式與術後腫瘤複髮率無關.鈥激光袖套狀切除膀胱-輸尿管下段是腎盂癌和輸尿管癌根治術中安全、微創的方法.
목적 평고화격광、전절급개방수술재상뇨로상피성악성종류근치술중수투상절제방광-수뇨관하단적림상료효. 방법 회고성분석2000년1월지2010년12월162례신우암、중상단수뇨관암환자적자료.신급근단수뇨관절제술채용개방혹후복강경법.수투상절제방광-수뇨관하단분별채용화격광(A조)32례、전절(B조)51례급개방수술(C조)79례.경뇨도수술조술중삽입5F수뇨관기낭도관이조단뇨류.병리진단균위신우화(혹)수뇨관상피암,병리분기위T(4)NoM0 ～T4N0M0.대3조위수술기지표(수술시간、술중실혈량、술중병발증、술후주원시간등)화술후수방결과(종류복발솔、종류충식발생솔、환자생존솔등)진행대조연구.술후수방3개월～8년. 결과 A、B조수술시간[(203.6±31.5),(207.2±24.3) min]、술중실혈량[(127.4±63.2),(135.0±82.7) ml]、술후주원시간[(5.8±1.3),(5.6±1.2)d]현저저우C조[(248.0±42.9) min,( 484.5±217.7)ml,(8.7±3.5)d,P＜0.01].B조술중발생폐공신경반사6례,방광천공합병교대출혈3례,기중중전개방수술2례.3조술후방광종류발생솔(16.3％、18.1％、21.7％)、종류충식발생솔(균위0)、1、3년생존솔(96.3％/90.5％、98.0％/88.6％、95.7％/86.4％)비교차이균무통계학의의(P＞0.05). 결론 경뇨도술식적창상정도、수술시간、술중실혈량、술후회복시간등위수술기지표현저우우전통개방수술,방광종류발생솔、종류충식발생솔、생존솔등여개방수술상당.수투상절제방광-수뇨관하단적수술방식여술후종류복발솔무관.화격광수투상절제방광-수뇨관하단시신우암화수뇨관암근치술중안전、미창적방법.
Objective To present the innovative transurethral resection of the distal ureter and bladder cuff by Holmium laser and to compare the perioperative and oncological outcomes following nephroureterectomy using three different methods of managing the distal ureter and bladder cuff. Methods From January 2000 to December 2010,162 patients underwent excision of the distal ureter and bladder cuff by transurethral Holmium laser (32 cases,Group A),transurethral electric resection (51 cases,Group B) or open procedure (79 cases,Group C) combined with open or retroperitoneal laparoscopic nephroureterectomy.5 French ureteral balloon catheter was inserted into the targeted ureter to prevent possible microscopic tumor seeding.The therapeutic effectiveness,perioperative complications,postoperative recovery and oncologic outcomes were compared among groups.The follow-up time was 3 -96 months. Results Group A and B showed statistically significant better results on the operative time (203.6 ± 31.5 min and 207.2 ±24.3 min),blood loss ( 127.4 ± 63.2 ml and 135.0 ± 82.7 ml) and postoperative hospital stay (5.8 ± 1.3d and 5.6 ±1.2 d) than those of Group C (248.0 ±42.9 min,484.5 ±217.7 ml,8.7 ±3.5 d),respectively ( P ＜ 0.01 ).Six cases of obturator nervous reflex occurred in Group B,with 3 cases of bladder peroration and 2 conversions to open procedure.There were no difference in bladder tumor occurrence,retroperitoneal recurrence,tumor cell seeding and cancer-specific survival among the 3 groups. Conclusions Our data have validated the superiority of transurethral approach over conventional open procedure including perioperative index,recovery and comparable oncologic outcomes with open group.Holmium laser demonstrated better results including fewer complication,cleaner surgical vision and operating accuracy than that of electric resection.Transurethral Holmium laser resection of the distal ureter and bladder cuff has been proved to be a technically innovative minimally invasive and oncological safe method.
