Retroperitoneal Laparoscopy Combined With Cystoscopic Electrocision For Therapy Of Upper Urinary Transitional Cell Carcinoma: Clinical Application And Prognosis

Objectives:To evaluate the clinical effect of retroperitoneal laparoscopy combined with transurethral plasmakinetic resection(group A)and combined abdominal small incision(group B)for the treatment of upper urinary tract transitional cell carcinoma,and to explore the risk factors of bladder recurrence after upper urinary tract transitional cell carcinoma.Methods:The clinical data of 36 cases of group A were analyzed retrospectively,and compared with the clinical data of group B at the same time.In group A,20 cases were male,16 cases were female;average age:67.6±9.9 years;the average body mass index(BMI):21.78±1.19kg/m2;17 cases left tumor,19 cases of right tumor;24 cases of carcinoma of renal pelvis,12 cases of ureteral cancer;preoperative imaging examination(take CT measurements as standards)suggested that the average tumor diameter was 2.47±0.71cm;the first symptom:22 cases with gross hematuria,low back pain in 10 cases,4 cases were found in physical examination;postoperative pathological report showed that urinary tract transitional cell carcinoma.In group B,there were 19 males and 17 females.The average age of patients:65.4±10.3 years;the average body mass index(BMI):21.55±1.46kg/m2;Among them,there were 15 cases of left side tumor and 21 cases of right side tumor;26 cases of carcinoma of renal pelvis,10 cases of ureteral cancer;preoperative imaging examinations(take CT measurements as standards)suggested an average tumor diameter of 2.31±0.55;the first symptom:20 cases of hematuria,11 cases of lumbago,medical examination found 5 cases;postoperative pathology reports all suggested urinary tract metastatic cell carcinoma.Compare the intraoperative conditions(surgical time,intraoperative blood loss),postoperative hospital stay,incidence of postoperative complications,and survival rate between the two groups;discuss age,gender,tumor size,tumor laterality,diameter of tumor,clinical stage and pathological grade of tumor TNM risk of recurrence of bladder cancer after RNU analysis,so as to evaluate the effect of transurethral bipolar plasmakinetic resection of retroperitoneal laparoscopic nephroureterectomy for upper urinary tract cancer cell shape shift clinical curative effect.Results:There were no statistically significant differences in gender,age,tumor diameter,tumor side,tumor location and postoperative pathological stage between the two groups(P>0.05).In group A,intraoperative blood loss was(188.20±27.40min)and postoperative hospital stay(6±2.2d)was less than that in group B(166.30±28.20min)and postoperative hospitalization time(8.0±3d),the difference was statistically significant(P<0.05).The operation time of group A(188.20±27.40min)was shorter than that of group B(166.30±28.20min),but the difference was not statistically significant(P>0.05).The incidence of complications in group A was 8.3%(3/36),and in group B was 13.9%(5/36),the difference was not statistically significant(P>0.05).The two groups were followed up for 12-48 months.The postoperative metastasis rate of group A was 11.1%(4/36),and that in group B was 8.3%(3/36).There was no statistical difference between the two groups.The survival rate analysis showed that there was no significant difference in survival rate,because the Kaplan-Meier survival curve showed that P=0.781.Postoperative tumor location,tumor size,tumor stage,and pathological grade of upper urinary tract metastatic carcinoma were risk factors for bladder recurrence(P<0.05),and clinical tumor TNM staging was an independent risk factor;while gender,age,tumor laterality and surgical procedures has no significant relationship with postoperative bladder recurrence(P>0.05).Conclusion:Retroperitoneal laparoscopic nephroureterectomy combined with transurethral plasmakinetic resection is safe and effective in the treatment of upper urinary tract metastatic cell carcinoma.Compared with combined abdominal small incision,it has the advantages of less intraoperative blood loss and short postoperative hospital stay.And the incidence of postoperative complications and survival rates were comparable.Tumor location,tumor size,tumor staging and pathological grading are risk factors for bladder recurrence.Clinical TNM staging is an independent risk factor for bladder recurrence after RNU.