Chung Shiu-Dong, Chen Shyh-Chyan, Wang Shuo-Meng, Chueh Shih-Chieh, Lai Ming-Kuen, Huang Chao-Yuan, Pu Yeong-Shiau, Huang Kuo-How, Yu Hong-Jeng
Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan.
J Endourol. 2009 Jan;23(1):75-80. doi: 10.1089/end.2008.0267.
To determine the feasibility and long-term outcomes of hand-assisted laparoscopic nephroureterectomy (HALNU) compared with open nephroureterectomy (ONU) in the management of pT(3)N0 upper urinary tract urothelial carcinoma (UUT-UC).
Between January 1994 and December 2005, 21 patients who underwent HALNU for stage pT(3)N0 UTT-UC were matched and compared with 31 patients who underwent ONU. The oncologic out-comes, including bladder recurrence, recurrence-free survival, cancer-specific survival, and overall survival, were statistically analyzed.
The median follow-up period in the HALNU group was 72 months (range 33-111 months) and 115 months in the ONU group (range 24-161 months). Patient age, sex, body mass index, tumor size, specimen weight, and American Society of Anesthesiologists classification showed no significant difference between the two groups. The HALNU group had statistically less blood loss than the ONU group (113 mL versus 487 mL; P = 0.02). The average hospital stay and doses of narcotic analgesics were significantly less in the HALNU group than the ONU group. The complication and bladder recurrence rates were similar between the two groups. The 5-year recurrence-free survival, cancer-specific survival, and overall survival were also comparable in both groups.
HALNU is a safe and efficacious procedure with comparable long-term oncologic outcomes in comparison with ONU in treating patients with locally advanced pT(3)N0UUT-UC.
确定在治疗pT(3)N0上尿路尿路上皮癌（UUT-UC）时，手辅助腹腔镜肾输尿管切除术（HALNU）与开放性肾输尿管切除术（ONU）相比的可行性及长期疗效。
1994年1月至2005年12月期间，21例行HALNU治疗pT(3)N0期UUT-UC的患者与31例行ONU的患者进行匹配及比较。对包括膀胱复发、无复发生存率、癌症特异性生存率及总生存率在内的肿瘤学结局进行统计学分析。
HALNU组的中位随访期为72个月（范围33 - 111个月），ONU组为115个月（范围24 - 161个月）。两组患者的年龄、性别、体重指数、肿瘤大小、标本重量及美国麻醉医师协会分级无显著差异。HALNU组的术中失血量在统计学上少于ONU组（113 mL对487 mL；P = 0.02）。HALNU组的平均住院时间及麻醉性镇痛药用量显著少于ONU组。两组的并发症及膀胱复发率相似。两组的5年无复发生存率、癌症特异性生存率及总生存率也相当。
在治疗局部晚期pT(3)N0 UUT-UC患者时，HALNU是一种安全有效的手术方式，与ONU相比具有相当的长期肿瘤学疗效。
