Rassweiler Jens J, Schulze Michael, Marrero Reinaldo, Frede Thomas, Palou Redorta Juan, Bassi Pierfrancesco
Department of Urology, SLK Kliniken Heilbronn, Am Gesundbrunnen 20, D-74078 Heilbronn, Germany.
Eur Urol. 2004 Dec;46(6):690-7. doi: 10.1016/j.eururo.2004.08.006.
In 1991, laparoscopic nephroureterectomy has been introduced as a treatment option for upper tract transitional cell carcinoma. Based on the review of the current literature and personal experience we want to analyze the actual results of this technique in comparison to open surgery.
We performed a MEDLINE/PubMed search and reviewed the literature on laparoscopic and open nephroureterectomy between 1991 and 2004 (n = 1365 patients) including the results of 45 patients who underwent either laparoscopic (n = 23) or open nephroureterectomy (n = 21) during the same period of time at the Klinikum Heilbronn. Demographic, perioperative and follow-up data were compared.
The analysis revealed a slightly longer OR-time (276.6 vs. 220.1 min), and significantly lower blood loss (240.9 vs. 462.9 ml) in the laparoscopic series. No differences of minor (12.9 vs. 14.1%) or major complication rate (5.6 vs. 8.3%) were observed. All nine comparative studies revealed a significant dose reduction of the morphine-equivalents after laparoscopy. In all ten comparative series the hospital stay was shorter after laparoscopy, but only in 6 series the difference was statistically significant. The frequency of bladder recurrence (24.0 vs. 24.7%), local recurrence (4.4 vs. 6.3%), and distant metastases (15.5% vs. 15.2) did not differ significantly in both groups. The actual disease-free two-year survival rates (75.2 vs. 76.2%) were similar. The five-year survival rates averaged 81.2% in the three laparoscopic (n = 113 pat.) and 61% in the ten open series (n = 681 pat.) Six port site metastases were reported in 377 (1.6%) analyzed patients occurring 3 to 12 months following laparoscopy.
Open radical nephroureterectomy still represents the golden standard for the management of upper tract transitional cell carcinoma, however, laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome. In case of advanced tumors (pT3,N+) open surgery is still recommended.
1991年，腹腔镜肾输尿管切除术被引入作为上尿路移行细胞癌的一种治疗选择。基于对当前文献的回顾和个人经验，我们希望分析该技术与开放手术相比的实际效果。
我们进行了MEDLINE/PubMed检索，并回顾了1991年至2004年间关于腹腔镜和开放肾输尿管切除术的文献（n = 1365例患者），包括同期在海尔布隆klinikum接受腹腔镜（n = 23）或开放肾输尿管切除术（n = 21）的45例患者的结果。比较了人口统计学、围手术期和随访数据。
分析显示，腹腔镜组的手术时间略长（276.6对220.1分钟），但失血量显著减少（240.9对462.9毫升）。未观察到轻微（12.9%对14.1%）或严重并发症发生率的差异（5.6%对8.3%）。所有九项比较研究均显示腹腔镜检查后吗啡等效剂量显著减少。在所有十项比较系列中，腹腔镜检查后的住院时间较短，但只有六项系列的差异具有统计学意义。两组的膀胱复发率（24.0%对24.7%）、局部复发率（4.4%对6.3%）和远处转移率（15.5%对15.2%）无显著差异。实际的无病两年生存率（75.2%对76.2%）相似。在三个腹腔镜组（n = 113例患者）中，五年生存率平均为81.2%，在十个开放手术组（n = 681例患者）中为61%。在377例（1.6%）分析患者中报告了6例端口部位转移，发生在腹腔镜检查后3至12个月。
开放性根治性肾输尿管切除术仍然是上尿路移行细胞癌治疗的金标准，然而，腹腔镜根治性肾输尿管切除术具有微创手术的优势，且不会恶化肿瘤学结果。对于晚期肿瘤（pT3，N+），仍建议采用开放手术。
