CAJ | 학술논문

目的：探讨腹腔镜辅助下肾输尿管全长切除术治疗肾盂癌的安全性及有效性。方法收集2009年1月至2014年8月间在我院采用两种不同术式行腹腔镜辅助下肾输尿管全长切除术的68例肾盂癌患者的临床资料，全腹腔镜下为A术式，即经后腹腔肾输尿管全长切除＋经腹腹腔镜膀胱壁内段袖状切除＋延长下腹部穿刺点切口取肾术，共行20例；对照研究组为B术式，即后腹腔镜肾输尿管全长切除＋经尿道电切膀胱袖状切除＋经下腹部切口取肾术，共行48例。比较两组手术时间、术中出血量、耻骨后留置引流管时间、导尿管留置时间、术后住院时间、术后早期并发症、局部复发、远处转移等指标。结果68例均顺利完成手术。A术式和B术式的手术时间分别为（220．19±37．21）和（210．31±42．21）min ，术中出血量分别为（104．35±24．36）和（134．02±53．50）ml ，耻骨后引流管留置时间分别为（3．1 ± 0．8）和（5．1 ± 2．3）d ，留置导尿管时间分别为（6．3±1．2）和（7．1±1．3）d，术后住院时间分别为（6．4±1．6）和（7．2±1．2）d。A 术式出现发热1例；B术式出现发热8例，漏尿2例，严重肉眼血尿6例，经对症处理痊愈。术后随访6～72个月，A术式复发及转移各1例，B术式分别为4和3例。A术式的术中出血量、耻骨后引流管留置时间、留置导尿管时间、术后住院时间、术后早期并发症均较B术式少，两者比较差异有统计学意义（P＜0．05）。结论经后腹腔肾输尿管全长切除＋经腹腹腔镜膀胱壁内段袖状切除＋延长下腹部穿刺点切口取肾术治疗肾盂癌具有损伤小、术后恢复快、住院时间短的优点，并不增加肿瘤复发转移率，是一种安全、有效的微创治疗方法。
목적：탐토복강경보조하신수뇨관전장절제술치료신우암적안전성급유효성。방법수집2009년1월지2014년8월간재아원채용량충불동술식행복강경보조하신수뇨관전장절제술적68례신우암환자적림상자료，전복강경하위A술식，즉경후복강신수뇨관전장절제＋경복복강경방광벽내단수상절제＋연장하복부천자점절구취신술，공행20례；대조연구조위B술식，즉후복강경신수뇨관전장절제＋경뇨도전절방광수상절제＋경하복부절구취신술，공행48례。비교량조수술시간、술중출혈량、치골후류치인류관시간、도뇨관류치시간、술후주원시간、술후조기병발증、국부복발、원처전이등지표。결과68례균순리완성수술。A술식화B술식적수술시간분별위（220．19±37．21）화（210．31±42．21）min ，술중출혈량분별위（104．35±24．36）화（134．02±53．50）ml ，치골후인류관류치시간분별위（3．1 ± 0．8）화（5．1 ± 2．3）d ，류치도뇨관시간분별위（6．3±1．2）화（7．1±1．3）d，술후주원시간분별위（6．4±1．6）화（7．2±1．2）d。A 술식출현발열1례；B술식출현발열8례，루뇨2례，엄중육안혈뇨6례，경대증처리전유。술후수방6～72개월，A술식복발급전이각1례，B술식분별위4화3례。A술식적술중출혈량、치골후인류관류치시간、류치도뇨관시간、술후주원시간、술후조기병발증균교B술식소，량자비교차이유통계학의의（P＜0．05）。결론경후복강신수뇨관전장절제＋경복복강경방광벽내단수상절제＋연장하복부천자점절구취신술치료신우암구유손상소、술후회복쾌、주원시간단적우점，병불증가종류복발전이솔，시일충안전、유효적미창치료방법。
Objective To evaluatethe safety and efficacy of laparoscopic nephroureterectomy . Methods Two kinds of laparoscopic nephroureterectomy were performed in 68 cases from January 2009 to August 2014 ,20 cases were underwent retroperitoneoscopic nephroureterectomy + trans‐peritoneal laparoscopic resection of the ureteral orifice with bladder cuff + extraction of the kidney and ureter by extend hypogastric puncture point (method A) ,retroperitoneoscopic nephroureterecto‐my + transurethral resection of the ureteral orifice with bladder cuff (method B) was performed in 48 cases .The operative time ,blood loss ,time of retropubic drainage ,catheterization time ,postop‐erative hospitalization time ,postoperative complications and postoperative local recurrence and dis‐tant metastasis were compared . Results Operation was successfully completed in all the 68 cases . The operative time ,blood loss ,time of retropubic drainage ,catheterization time ,postoperative hos‐pitalization time in method A group and method B group were (220.19 ± 37 .21) and (210 .31 ± 42.21) min ,(104 .35 ± 24 .36) and (134 .02 ± 53 .50) ml ,(3 .1 ± 0 .8) and (5 .1 ± 2 .3) d ,(6 .3 ± 1.2) and (7 .1 ± 1 .3) d ,(6 .4 ± 1 .6) and (7 .2 ± 1 .2) d respectively .One patient complicated with fever in group A ,eight in group B ,two complicated with leakage of urine and six with severe hema‐turia in group B ,they were cured by symptomatic treatment .During six to seventy‐two months follow‐up ,our investigation showed that there was one recurrent and metastatic case in group A respectively and four recurrence and three metastases in group B respectively .The blood loss ,time of retropubic drainage ,catheterization time ,postoperative hospitalization time ,postoperative complications were significantly different between the two groups (P<0 .05) . Conclusions Retroperitoneoscopic nephroureterectomy + transperitoneal laparoscopic resection of the ureteral orifice with bladder cuff + extraction of the kidney and ureter by extend hypogastric puncture point has the advantages of less inva‐sive ,less blood loss ,rapid recovery ,shorter time of hospitalization and does not increase the recurrence of carcinoma .It is a minimally invasive ,safe and effective method of treatment for renal pelvis carcinoma .