Comparative Study Of Three Kind Of Surgical Procedures For Treating Upper Tract Urothelial Carcinoma With Laparoscopic Approach

?Objective? To compare the Advantages and disadvantages as well as the clinical efficacy of completely transperitoneal laparoscopic nephroureterectomy and retroperitoneal laparoscopy combined open distal ureterectomy as well as retroperitoneal laparoscopy combined transurethral resection of the ureteral orifice for treating the upper tract urothelial carcinoma.?Materials and methods? Retrospective analysis clinical data of 59 patients suffering from upper tract urothelial carcinoma with operative treatment and postoperative pathology confirmed from urological department of Fujian Provincial Hospital from January 2011 to June 2016 were reviewed.Patients were divided into three groups to compare,20 patients underwent completely laparoscopic nephroureterectomy(group A),21 patients underwent retroperitoneal laparoscopy combined transurethral resection of the ureteral orifice(group B),20 patients underwent retroperitoneal laparoscopy combined open distal ureterectomy(group C).We compared the gender,ege,body mass index,initial symptom,tumor size,tumor location,operation time,intraoperative estimated blood loss,recovery time of Gastrointestinal function,the usage time of postoperative analgesic,hemostatic application time,catheter indwelling time,postoperative drainage tube indwelling time and postoperative hospital stay between the three groups.Patients were followed up for 6-48 months,and postoperative bladder tumor recurrence and tumor distant metastasis were recorded.?Results? All patients of the three groups of were successfully completed surgery,the completely laparoscopic group(group A)had no conversion to open surgery.Gender,Age,the weight,BMI,the tumor size on imaging and the tumor side(left and right)and position(pelvic tumors,ureteral tumor,renal pelvis tumor with ureteral tumor)were not significantly different in the three groups.group A(Completely laparoscopic group),group B(transurethral resection group)and group C(open group),the three groups of cases were not statistical differences(p > 0.05)in postoperative gastrointestinal function recovery time(1.7±0.7d VS 2.2±0.9d VS 2.1±1.0d,p=0.176),Intraperitoneal or retroperitoneal drainage tube indwelling time(7.4±3.2d VS 8.8±4.4d VS 8.3±3.1,p=0.476),pelvic drainage tube indwelling time(9.0±2.8d VS 12.0±4.6d VS 10.5±3.5,P=0.086).Group A,group B and group C were statistical differences in operating time(163.9±28.1min VS 190.4±23.9min VS 183.4±22.5min,P1=0.002?P2=0.019?P3=0.365),intraoperative estimated blood loss(117.5±37.5ml VS 161.0±34.6ml VS 144.5±47.1ml,P1=0.001 ?P2=0.043?P3=0.193),the time of using hemostatic(2.9±1.7d VS 4.2±1.8d VS 4.0±1.1d,P1=0.009 ?P2=0.007?P3=0.757),the time of using acesodyne(2.7±1.3d VS 4.6±2.1 VS 3.8±1.6d,P1=0.003 ?P2=0.021?P3=0.241),postoperative length of hospital stay(10.6±3.2d VS 16.2±5.1 VS 13.4±4.1d,P1=0.001 ?P2=0.032?P3=0.086)(P1: group A compared with group B;P2: group A compared with group C;P3: group B compared with group C.)Group A(completely laparoscopic group)is better than group B(transurethral resection group)and group C(open group)in operation time,intraoperative estimated blood loss,the time of using hemostatic,the time of using acesodyne and postoperative hospital stay(p < 0.05,P2 < 0.05);Group A(completey laparoscopic group)and group C(open group)is better than group B(transurethral resection group)in the aspect of urethral catheter time(p < 0.05,P3 < 0.05);Group B and group C were not statistically significantly differences in operation time,intraoperative estimated blood loss,the time of using hemostatic,the time of using acesodyne,postoperative hospital stay(P3 > 0.05).Group A median follow-up time was 13.2±3.8 months,group B average follow-up time was25.8±11.2months,group C average follow-up time was 26.3±12.4 months follow-up time of group A and group B and C groups had significant difference(p < 0.05,P2 < 0.05);The three groups were not statistical difference in bladder tumor recurrence and distant metastasis rate(P > 0.05).?Conclusions? Through the comparison research,we think that completely laparoscopic nephroureterectomy and ureter and bladder cuff resection surgery don't need to change the position,abdominal operation space is large,the anatomy is clear,and strictly follow the principle of oncology effect a radical cure.compared to retroperitoneal laparoscopy combined open abdominal incision and retroperitoneal laparoscopy combined Urethral resectoscope With lower abdominal oblique small incision surgery treatment of the upper tract urothelial carcinoma,completely laparoscopic nephroureterectomy has the advantages of less intraoperative bleeding,less trauma to the patient,reduce the reduce the patient pain of patients rapid recovery,patients recover quickly,shorten the time of hospitalization.And Conform to the requirements of the minimally invasive surgery,furthermore it is safe and effective,It is an ideal surgical method to Treatment of upper tract urothelial carcinoma,worthy of clinical promotion.