Song Liming, Wang Wenkuan, Zhao Qinxin, Wen Yuhong, Zhou Xiaoguang, Han Hu, Zhang Xiaodong
Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Urology, Beijing Haidian Hospital/Haidian Hospital of Beijing University Third Hospital, Beijing, People's Republic of China.
Cancer Manag Res. 2020 Jul 13;12:5721-5728. doi: 10.2147/CMAR.S259964. eCollection 2020.
The traditional surgical treatment for upper urinary tract urothelial carcinoma (UTUC) is time-consuming owing to changing the surgical position and larger surgical trauma because of open surgery in handling the distal ureter. Therefore, we created a new surgical technique of combination retroperitoneal with transperitoneal (CRT) laparoscopic nephroureterectomy (LNU) in a single position and here report our early outcomes.
From January 2017 to December 2019, a total of 106 patients underwent LNU by a single surgeon at our department, of whom 50 patients underwent standard technique and 56 patients underwent CRT technique. Relevant clinical data were collected including each patient's characteristics, surgical outcomes, and follow-up results. A comparative analysis between standard LNU cases and CRT LNU cases was performed.
LNU was performed successfully on all 106 patients. There was no significant difference in patients' characteristics. Compared to the standard group, patients in the CRT group had shorter operative time (=0.001), less estimated blood loss (EBL) (<0.001), lower visual analogue scale (VAS) pain score (=0.020) and less scarring (=0.013). The median time of surgical drain stay decreased from 5 to 2 days (=0.004) and median hospital stay after surgery decreased from 5 to 3 days (=0.001). The complication rates did not show statistical differences between the two groups within the first 30 days postoperatively (=0.263). For the long-term complications, the incidence of abdomen bulge or incisional hernia in the CRT group was less than that in the standard group (<0.001).
The CRT technique, which combines both the advantages of retroperitoneal and transperitoneal approaches, is a more minimally invasive, simplified and effective way to perform the LNU.
上尿路尿路上皮癌（UTUC）的传统手术治疗由于需要改变手术体位而耗时较长，并且因开放手术处理远端输尿管会导致较大的手术创伤。因此，我们开创了一种在单一手术体位下联合后腹腔镜与经腹腔（CRT）的腹腔镜肾输尿管切除术（LNU）新技术，在此报告我们的早期手术结果。
2017年1月至2019年12月，共有106例患者在我科由同一位外科医生实施LNU，其中50例患者采用标准技术，56例患者采用CRT技术。收集相关临床资料，包括每位患者的特征、手术结果和随访结果。对标准LNU病例和CRT LNU病例进行比较分析。
106例患者均成功实施LNU。患者特征方面无显著差异。与标准组相比，CRT组患者手术时间更短（=0.001），估计失血量（EBL）更少（<0.001），视觉模拟评分（VAS）疼痛评分更低（=0.020），瘢痕形成更少（=0.013）。手术引流管留置时间中位数从5天降至2天（=0.004），术后住院时间中位数从5天降至3天（=0.001）。术后30天内两组并发症发生率无统计学差异（=0.263）。对于远期并发症，CRT组腹部膨隆或切口疝的发生率低于标准组（<0.001）。
CRT技术结合了后腹腔镜和经腹腔两种入路的优点，是一种更微创、简化且有效的LNU手术方式。
