Comparative Study Of Three Laparoscopic Techniques In The Treatment Of Upper Urinary Tract Urothelial Carcinoma

Objective :To compare clinical efficacy and safety between the complete transperitoneal laparoscopic nephroureterectomy(CTLNU),traditional retroperitoneal laparoscopic nephroureterectomy(TRLNU)and retroperitoneal laparoscopic nephroureterectomy combined with transurethral electric resection(RLNU-TER)for the treatment of upper tract urothelial carcinoma(UTUC).Materials and methods:Retrospectively analyze the clinical data of 74 UTUC patients who met the inclusion and exclusion criteria admitted to the First Affiliated Hospital of Nanchang University from January 2014 to June 2019,including 26 cases in the CTLNU group(group A),and the TRLNU group(B Group)33 cases,RLNU-TER group(group C)15 cases.Compare the differences in general clinical data,perioperative parameters and postoperative follow-up results among the three groups of patients.Results:There was no significant statistical difference in gender,age,body mass index(BMI),tumor side(left or right),tumor location(renal pelvis,ureter or renal pelvis with ureter),tumor diameter,tumor stage,tumor differentiation between in the groups A,B and C(P>0.05).There was no significant difference in the incidence of postoperative complications,tumor recurrence and metastasis rates among the three groups(P>0.05).There was no significant difference between group A and group C in terms of intraoperative blood loss and indwelling time of abdominal drainage tube(P>0.05).There were significant statistical differences in operation time,gastrointestinal function recovery time,pelvic drainage tube indwelling time,urinary catheter indwelling time and postoperative hospital stay in group A and group C(P<0.05).The operation time of group A(167.4±40.7 min)was shorter than that of group B(206.8±42.5 min)and group C(212.3±35.7 min)(P<0.05),but there was no significant difference between group B and group C(P >0.05).The recovery time of gastrointestinal function in group A was significantly longer than that in group B and C(3.3±1.1 vs 2.0±0.6 vs 2.1±0.6 d,P<0.001),but there was no significant difference between group B and group C(P=1.000).The indwelling time of the pelvic drainage tube in group C(6.3±2.0 d)was significantly longer than that in group A(4.7±1.9 and group B(5.1±1.5 d)(P<0.05)),but there was no statistical difference between group A and group B Academic significance(P>0.05).The catheter indwelling time in group C(10.0±2.2 d)was significantly longer than that in group A(4.5±2.3 d)and group B(5.0±2.3 d)(P<0.05),but group A Compared with group B,there was no significant difference(P>0.05).The postoperative hospital stay of group A(9.1±2.2 d)was significantly less than that of group B(11.8±2.4 d)and group C(11.2±1.6 d)(P<0.05),but there was no significant difference between group B and group C(P=1.000).Conclusions:Compared with TRLNU and RLNU-TER,CTLNU has shorter operation time and postoperative hospital stay.The recovery time of gastrointestinal function of TRLNU and RLNU-TER was earlier than that of CTLNU.Compared with CTLNU and TRLNU,RLNU-TER has longer indwelling time for pelvic drainage tube and longer indwelling time for urinary catheter.There were no significant differences in the amount of intraoperative blood loss,the indwelling time of the abdominal drainage tube,the rate of postoperative complications,and the rate of postoperative tumor recurrence and metastasis between the three surgical methods.