Jarrett T W, Chan D Y, Cadeddu J A, Kavoussi L R
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Urology. 2001 Mar;57(3):448-53. doi: 10.1016/s0090-4295(00)01043-8.
To establish the safety and efficacy of laparoscopic and laparoscopic-assisted nephroureterectomy.
Since 1993, 25 patients with a minimum of 12 months of follow-up underwent nephroureterectomy using a total laparoscopic or laparoscopic-assisted technique. Four patients had specimen morcellation for tissue removal. All patients had regular follow-up with physical examinations, interval cystoscopy, and radiographs, depending on the metastatic potential of the tumor. Retrospective chart review was performed and assessed for operative time, blood loss, tumor pathologic stage, complications, and outcome. One patient was excluded because of an open conversion due to multiple previous abdominal surgeries and failure to progress.
The mean operating time was 329 minutes but decreased with experience. The median hospital stay was 4 days. Tumor stage was directly related to tumor grade. Associated bladder tumors (prior history or recurrent tumors) occurred in 50% of the patients. Ipsilateral ureteral stump site recurrence occurred in 1 patient. Although no port site seeding occurred, 1 patient, whose tumor was discovered histologically after laparoscopic pyeloplasty for presumed benign disease, developed recurrence in the renal fossa and metastatic disease. Two patients developed liver metastasis.
Total laparoscopic and laparoscopic-assisted nephroureterectomy are acceptable alternatives to open surgery in the treatment of transitional cell carcinoma of the upper urinary tract. Tumor morcellation did not appear to adversely affect patient outcome. As with open nephroureterectomy, tumor grade is the most important prognostic indicator of local, bladder, and metastatic recurrence. No port site seeding was observed in either the total laparoscopic or laparoscopic-assisted groups.
确立腹腔镜及腹腔镜辅助下肾输尿管切除术的安全性和有效性。
自1993年起，25例患者接受了全腹腔镜或腹腔镜辅助技术下的肾输尿管切除术，且至少随访12个月。4例患者采用标本粉碎术取出组织。所有患者根据肿瘤转移潜能，定期接受体格检查、间歇性膀胱镜检查及影像学检查。进行回顾性病历审查，评估手术时间、失血量、肿瘤病理分期、并发症及预后。1例患者因既往多次腹部手术及手术进展不顺而中转开放手术，被排除在外。
平均手术时间为329分钟，但随着经验积累而缩短。中位住院时间为4天。肿瘤分期与肿瘤分级直接相关。50%的患者伴有膀胱肿瘤（既往病史或复发性肿瘤）。1例患者同侧输尿管残端部位复发。虽然未发生穿刺孔种植转移，但1例患者在因疑似良性疾病行腹腔镜肾盂成形术后经组织学检查发现肿瘤，出现肾窝复发及转移。2例患者发生肝转移。
全腹腔镜及腹腔镜辅助下肾输尿管切除术是治疗上尿路移行细胞癌的可接受的开放手术替代方案。肿瘤粉碎术似乎未对患者预后产生不利影响。与开放性肾输尿管切除术一样，肿瘤分级是局部、膀胱及转移复发的最重要预后指标。在全腹腔镜组或腹腔镜辅助组中均未观察到穿刺孔种植转移。
