Hattori Ryohei, Yoshino Yasushi, Gotoh Momokazu, Katoh Masashi, Kamihira Osamu, Ono Yoshinari
Department of Urology, Nagoya University Graduate School of Medicine, Komaki Shimin Hospital, Nagoya-shi, Japan.
Urology. 2006 Apr;67(4):701-5. doi: 10.1016/j.urology.2005.10.022. Epub 2006 Mar 29.
To evaluate the efficacy of retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter, we analyzed the clinical outcomes and long-term cancer control of 89 patients.
In 36 patients, the kidney was retroperitoneoscopically dissected and the ureteral end was resected with open procedure (combined laparoscopy group). In 53 patients, the ureteral end with a bladder cuff was transected using an endoscopic stapler (pure laparoscopy group). Sixty patients underwent open nephroureterectomy (open group). The median follow-up period was 35, 31, and 17 months in the open, combined, and pure laparoscopy groups, respectively.
The average operative time and bleeding volume was 5.4 hours and 665 mL in the open group, 5.1 hours and 580 mL in the combined laparoscopy group, and 4.3 hours and 354 mL in the pure laparoscopy group, respectively. The cause-specific patient survival rate at 3 years was 81% in the open group, 86% in the combined laparoscopy group, and 80% in the pure laparoscopy group. The bladder recurrence-free rate at 3 years was 51% in the open group, 65% in the combined laparoscopy group, and 45% in the pure laparoscopy group. The extravesical recurrence-free rate at 3 years was 71% in the open surgery group, 76% in the combined laparoscopy group, and 71% in the pure laparoscopy group. No statistically significant difference was seen in patient survival, bladder recurrence, or extravesical recurrence rates among the three groups.
Our retroperitoneal laparoscopic nephroureterectomy is less invasive than open surgery and is a safe and effective alternative.
为评估后腹腔镜肾输尿管切除术治疗肾盂及输尿管移行细胞癌的疗效，我们分析了89例患者的临床结局及长期癌症控制情况。
36例患者经后腹腔镜解剖肾脏，输尿管末端采用开放手术切除（腹腔镜联合组）。53例患者使用内镜吻合器横断带膀胱袖套的输尿管末端（单纯腹腔镜组）。60例患者接受开放肾输尿管切除术（开放组）。开放组、腹腔镜联合组和单纯腹腔镜组的中位随访时间分别为35个月、31个月和17个月。
开放组平均手术时间和出血量分别为5.4小时和665毫升，腹腔镜联合组为5.1小时和580毫升，单纯腹腔镜组为4.3小时和354毫升。开放组3年的特定病因患者生存率为81%，腹腔镜联合组为86%，单纯腹腔镜组为80%。开放组3年无膀胱复发率为51%，腹腔镜联合组为65%，单纯腹腔镜组为45%。开放手术组3年无膀胱外复发率为71%，腹腔镜联合组为76%，单纯腹腔镜组为71%。三组患者生存率、膀胱复发率或膀胱外复发率无统计学显著差异。
我们的后腹腔镜肾输尿管切除术比开放手术创伤小，是一种安全有效的替代方法。
