Comparative Study Of Transabdominal Laparoscopic Radical Nephroureterectomy And Open Surgery

Objective: To compare the advantages and disadvantages of transabdominal total laparoscopic nephroureterectomy and traditional open surgery in the treatment of renal pelvis carcinoma.Methods: A retrospective study was performed in 60 patients who underwent renal ureteral resection in the Liaoning Provincial Cancer Hospital from January 2015 to January 2018.The clinical symptoms of most patients before operation were intermittent,painless,whole course gross hematuria,with or without discomfort symptoms of the diseased side of the waist.ECG,pulmonary function test,color Doppler ultrasound,CTU and urine exfoliative cytological screening were performed routinely before operation.If necessary,MRI and other imaging examinations were performed.No or Nx of regional lymph nodes,no adrenal metastasis and distant metastasis were found,and tumor thrombus of renal vein and inferior vena cava were excluded.The normal urethra and bladder mucosa were detected by cystoscopy before operation,ureteroscopic exploration of ureter and pathological biopsy were performed,After diagnosis,transabdominal laparoscopic nephroureterectomy or radical nephroureterectomy under open operation was performed.All cases were selected according to the inclusion criteria.No distant metastasis was found in all patients,and there were no important organ diseases such as heart and lung.According to the surgical procedure,30 patients in the laparoscopic nephroureterectomy(LNU group)and 30 patients in the open nephroureterectomy(ONU group)were included.For the two groups,the operation time,intraoperative blood loss,blood transfusion,recovery time of gastrointestinal function after operation,removal time of drainage tube after operation,complications,hospital stay and histopathological indexes after operation were analyzed.The recurrence and metastasis of tumors were followed up after operation.Results: All the operations were completed successfully.In the laparoscopy group,there were no cases of conversion to opening,no cases of death.According to the preoperative data of LNU group and ONU group,there was no significant difference in age,sex,tumor location and size,preoperative tumor stage(P > 0.05),which indicated that the balance of the two groups was good and comparable.The operation time of the laparoscopic group(LNU group)and the open group(ONU group)were(163.90±7.12)min and(158.70±6.93)min,respectively.The intraoperative blood loss was(103.50±94.18)ml and(195.83±110.60)ml,postoperative gastrointestinal function recovery time was(1.43±0.57)d and(3.10± 0.71)d,the extraction time of the abdominal drainage tube was(3.07±0.78)d and(5.83±1.02)d and postoperative hospital stay(6.17±1.02)d and(10.03±0.99)d,The above differences were statistically significant(P<0.05).The incidence of postoperative complications in the two groups was 3.33% and 10.00%,respectively.The intraoperative and postoperative blood transfusion rates were 3.33% vs 3.33% and 3.33% vs 6.67%,respectively.But the postoperative complications and blood transfusion in the two groups were There was no significant difference in the rate,pathological type,pathological stage and pathological grade,lymph node invasion and tissue margin(P>0.05).All patients in the LNU group and the ONU group were followed up for 12-24 months,and no tumor recurrence and metastasis were found.Conclusion: Radical resection of renal pelvis carcinoma by laparoscopy has the advantages of less injury,less intraoperative blood loss,early anal exsufflation,faster recovery of gastrointestinal function,shorter average hospitalization time,which alleviates the pain of the patients.Compared with open surgery,the curative effect of radical resection of bladder tumor was not different,and the recurrence rate of bladder tumor was not increased,and the short-term effect was satisfactory.