Xuechuan Yan, Kai Zhao, Zongliang Zhang, Xinbao Yin, Guanqun Zhu, Han Yang, Ke Wang
Liaoning University of Traditional Chinese Medicine, Shenyang, 110000, China.
Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266550, China.
Int Urol Nephrol. 2025 Apr;57(4):1135-1141. doi: 10.1007/s11255-024-04293-1. Epub 2024 Nov 26.
The standard of care for upper tract urothelial carcinoma (UTUC) traditionally involved open nephroureterectomy with bladder cuff excision. Despite the adoption of transabdominal laparoscopic one-stage nephroureterectomy to mitigate this, the persistently high rate of postoperative intestinal obstruction remains a clinical challenge. This study introduces an innovative approach: a single-position, completely retroperitoneal laparoscopic nephroureterectomy coupled with a 75-45-degree positional change for bladder cuff resection in the treatment of UTUC. The study further evaluates the clinical efficacy of this novel surgical technique.
A retrospective analysis was conducted on 125 patients diagnosed with UTUC who underwent radical nephroureterectomy at our institution between May 2018 and December 2023. The experimental cohort comprised 65 individuals who received total retroperitoneal one-position laparoscopic nephroureterectomy (TROLN), complete with total intracorporeal bladder cuffing and distal ureterectomy. In contrast, the control cohort included 60 patients who had laparoscopic nephrectomy with a lower abdominal oblique incision for bladder sleeve resection. The study evaluated various perioperative metrics, such as operative duration, blood loss during surgery, incision size, resumption of oral intake postoperatively, drainage tube removal timeline, hospital stay duration, Visual Analogue Scale (VAS) for pain assessment, and complication incidence. In addition, pathological and oncological outcomes were scrutinized.
The TROLN group exhibited pronounced benefits across various surgical outcomes, including reduced operative duration, minimized intraoperative blood loss, shorter incision lengths, lower postoperative pain assessments, expedited return to oral nutrition, swifter drain extraction, and a condensed overall hospitalization period (all P < 0. 05). However, the oncological outcomes showed no significant differences between the TROLN group and the control group.
Drawing from our clinical insights, TROLN is a safe and effective modified technique that offers advantages over traditional laparoscopic combined with open surgery for treating UTUC, including reduced invasiveness, less bleeding, fewer complications, and shorter hospital stays. However, additional prospective studies are imperative to validate these observations.
上尿路尿路上皮癌（UTUC）的传统治疗标准是开放性肾输尿管切除术并切除膀胱袖口组织。尽管采用经腹腹腔镜一期肾输尿管切除术来缓解这一情况，但术后肠梗阻的持续高发生率仍然是一个临床挑战。本研究引入了一种创新方法：采用单一位置、完全后腹腔镜肾输尿管切除术，并在治疗UTUC时通过75至45度的体位改变进行膀胱袖口切除。该研究进一步评估了这种新型手术技术的临床疗效。
对2018年5月至2023年12月期间在本机构接受根治性肾输尿管切除术的125例诊断为UTUC的患者进行回顾性分析。实验组包括65例接受完全后腹腔镜单一位置肾输尿管切除术（TROLN）的患者，同时进行完全体内膀胱袖口缝合和远端输尿管切除术。相比之下，对照组包括60例通过下腹部斜切口进行腹腔镜肾切除术并切除膀胱袖状组织的患者。该研究评估了各种围手术期指标，如手术时间、术中失血量、切口大小、术后恢复经口进食情况、引流管拔除时间、住院时间、疼痛评估的视觉模拟量表（VAS）以及并发症发生率。此外，还对病理和肿瘤学结果进行了审查。
TROLN组在各种手术结果方面表现出明显优势，包括缩短手术时间、减少术中失血量、缩短切口长度、降低术后疼痛评估、加快恢复经口营养、更快拔除引流管以及缩短总体住院时间（所有P < 0.05）。然而，TROLN组与对照组之间的肿瘤学结果没有显著差异。
根据我们的临床观察，TROLN是一种安全有效的改良技术，与传统腹腔镜联合开放手术治疗UTUC相比具有优势，包括侵袭性降低、出血减少、并发症减少以及住院时间缩短。然而，需要更多的前瞻性研究来验证这些观察结果。
