CAJ | 학술논문

目的比较腹腔镜下手术治疗上尿路移行细胞癌的不同路径、输尿管处理方法及其适应证. 方法 94例上尿路移行细胞癌患者,均行肾、输尿管切除并膀胱袖状切除.分2组:①A组63例,为肾盂及输尿管上段肿瘤患者,采用后腹腔镜联合经尿道电切法;②B组31例,为输尿管中下段肿瘤患者及6例输尿管局部浸润患者,采用70°斜卧位经腹腔途径.观察2组手术时间、术中出血量,术后肠道功能恢复时间及术后并发症等. 结果 94例手术均成功,无术中并发症.2组平均手术时间分别为156和161 min,平均术中出血量分别为80和86 ml,术后胃肠功能恢复时间分别为24～48和24~72 h,术后平均住院时间分别为8.0和8.5 d.A组发生尿外渗2例,放置腹膜后引流管7 d愈合;形成尿囊肿1例,B超引导下穿刺引流治愈.84例获随访,平均随访23个月.2组分别有3例和5例膀胱镜检查发现膀胱肿瘤,2组均无切口及穿刺孔种植转移. 结论腹腔镜下肾、输尿管全切和膀胱袖状切除治疗上尿路移行细胞癌安全可行,应根据肿瘤位置和是否发生局部浸润来选择手术方式.
목적 비교복강경하수술치료상뇨로이행세포암적불동로경、수뇨관처리방법급기괄응증. 방법 94례상뇨로이행세포암환자,균행신、수뇨관절제병방광수상절제.분2조:①A조63례,위신우급수뇨관상단종류환자,채용후복강경연합경뇨도전절법;②B조31례,위수뇨관중하단종류환자급6례수뇨관국부침윤환자,채용70°사와위경복강도경.관찰2조수술시간、술중출혈량,술후장도공능회복시간급술후병발증등. 결과 94례수술균성공,무술중병발증.2조평균수술시간분별위156화161 min,평균술중출혈량분별위80화86 ml,술후위장공능회복시간분별위24～48화24~72 h,술후평균주원시간분별위8.0화8.5 d.A조발생뇨외삼2례,방치복막후인류관7 d유합;형성뇨낭종1례,B초인도하천자인류치유.84례획수방,평균수방23개월.2조분별유3례화5례방광경검사발현방광종류,2조균무절구급천자공충식전이. 결론 복강경하신、수뇨관전절화방광수상절제치료상뇨로이행세포암안전가행,응근거종류위치화시부발생국부침윤래선택수술방식.
Objective To analyze the different approaches and their indications in the laparo-scopic treatment of upper urinary tract transitional cell carcinoma. Methods 94 patients with upper urinary tract transitional cell carcinoma were divided to two groups. Group A (63 cases) with renal pelvic and ugper ureteral carcinoma were treated with retroperitoneal approach laparoscopic surgery and transurethral reseetoscope surgery. Group B (31 cases) with middle ureteral carcinoma including 6 cases with ureteral local infiltration were treated through 70° recumbent position transperitoneal ap-proach laparoscopic surgery combined with bladder cuff resection. The operative time, blood loss, the intestinal functional recovery time and post-operative complications were recorded. Results All 94 procedures were successfully completed, with no complication during the surgery. The mean operation time of A and B group was 156.5 and 160.8 min;the mean blood loss was 80 and 86 ml; the mean hos-pital stay was 8 and 8. 5 d; the time of bowel functional recovery of group A and group B was 24-48 and 24-72 h, respectively. 84 cases were followed-up with mean follow-up time of 23 months. Three eases and 5 cases were found having bladder tumor in the group A and group B. The incision and port metastasis was not found. Conclusions It is safe and feasible to treat the upper urinary tract transi-tional cell carcinoma laparoscopically. The selection of operating approach is mainly based on the loca-tion and local infiltration status of the tumor.