Busby J Erik, Brown Gordon A, Matin Surena F
Department of Urology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Urology. 2008 Mar;71(3):413-6. doi: 10.1016/j.urology.2007.10.028.
Laparoscopic nephroureterectomy (LNU) is an accepted treatment for tumors of the ureter and renal pelvis, although the ability to perform a regional lymphadenectomy has been criticized. We compared the quality of lymphadenectomy with LNU with that involving open nephroureterectomy (ONU) to determine whether oncologic principles are maintained.
We searched our institutional database for patients who had undergone ONU from 1990 to 2005. These were compared with a series of patients from January 2003 to April 2007 who underwent LNU. From each patient's medical records, we assessed the number of lymph nodes removed, the number of positive nodes removed, and the density of positive nodes. The differences between groups were analyzed using the Wilcoxon rank sum statistical test.
We identified 106 patients who underwent ONU with lymphadenectomy and 28 who underwent LNU with lymphadenectomy. The median number of nodes removed, median number of positive nodes, and median density of positive nodes were, respectively, 3, 0, and 0 for the ONU group; and 6, 0, and 0, for the LNU group. There was a statistically significant difference between groups with respect to the number of nodes removed (P = 0.01) but not with respect to the number of positive nodes removed (P = 0.61) or the lymph node density (P = 0.42).
Offsetting the benefits of laparoscopy could be a flawed oncologic technique. We have demonstrated that lymphadenectomy, which is a potentially important component of nephroureterectomy, can be performed as well during LNU as it is with ONU when a dedicated effort is made.
腹腔镜肾输尿管切除术（LNU）是治疗输尿管和肾盂肿瘤的一种公认方法，尽管其进行区域淋巴结清扫的能力受到了批评。我们比较了LNU与开放性肾输尿管切除术（ONU）的淋巴结清扫质量，以确定是否能遵循肿瘤学原则。
我们在机构数据库中搜索了1990年至2005年接受ONU的患者。将这些患者与2003年1月至2007年4月接受LNU的一系列患者进行比较。从每位患者的病历中，我们评估了切除的淋巴结数量、切除的阳性淋巴结数量以及阳性淋巴结密度。使用Wilcoxon秩和统计检验分析组间差异。
我们确定了106例行ONU并进行淋巴结清扫的患者和28例行LNU并进行淋巴结清扫的患者。ONU组切除的淋巴结中位数、阳性淋巴结中位数和阳性淋巴结密度分别为3、0和0；LNU组分别为6、0和0。两组在切除的淋巴结数量方面存在统计学显著差异（P = 0.01），但在切除的阳性淋巴结数量（P = 0.61）或淋巴结密度（P = 0.42）方面无差异。
抵消腹腔镜手术益处的可能是有缺陷的肿瘤学技术。我们已经证明，淋巴结清扫作为肾输尿管切除术的一个潜在重要组成部分，在LNU过程中只要付出专门努力，就能像在ONU中一样顺利进行。
