| Objective;To evaluate the effectiveness and safety of retroperitioneal laparoscopic radical nephroureterectomy for upper tract tumor.Methods:From March 2011 to September 2014,41 cases with urinary tract urothelial carcinoma(UTUC),underwent radical nephroureterectomy.The patients were divided into two groups according to different surgery methods(Group A:retroperitioneal laparoscopic radical nephroureterectomy,LRNU;Group B:retroperitioneal laparoscopic combined urethral resectoscopy nephroureterectomy).There were 17 cases in the observation group A,including 11 males and 6 females,with an average age of(60.6±5.8)years.The control group consisted of 34 patients,17 males and 7 females,with an average age of(63.2±4.9)years.All patients were diagnosed as upper urinary epithelial tumors by cytology and CT urography(CTU)before operation,and no bladder implantation and distant metastasis were confirmed by pelvic CT and cystoscopy.All patients did not receive chemotherapy,radiotherapy or targeted immunotherapy before operation.There were no significant abnormalities in the function of heart,lung and other important organs,and they could tolerate surgery.Both groups were given general anesthesia.Operative methods in observation group:after successful anesthesia,the patient first took the healthy side of the folding knife position,waist cushion high.The first puncture hole was made at 2-3cm above the iliac crest of the midaxillary line and 1-2cm on the ventral side.10mm Trocar was inserted as the observation hole.The adipose tissue was observed and separated.simply by the observation microscope.The second and third puncture holes were 10 mm and 5 mm Trocar under 12 ribs of the posterior axillary line and the front axillary line respectively.The fourth puncture hole was made at the level of the mirror hole and about 2 cm outside the front axillary line.In the first,second and third puncture holes,the kidneys were excised by routine retroperitoneal approach,and the ureters were separated downward as far as possible until the entrance of the bladder was enlarged.The location of the tumors was determined.The ureters were clamped with Hemolock at the distal.Under direct vision,part of the bladder wall was resected.The specimens were taken out.Sewed up the incision.Operative methods in the control group:after successful anesthesia,the kidney was resected by routine retroperitoneal approach.The ureter was free downward as far as possible.Trocar was removed and the puncture hole was sutured.Then the patient was changed to lithotomy position.Oblique incision was taken at McBurney's point or anti-McBurney's point for about 5-7cm.The kidney and ureter were found and separated downward.At the same time,the bladder mucosa was incised annularly at 0,5 cm outside the ureteral orifice on the affected side,and the fat outside the bladder was removed by appropriate traction of the ureter.The specimens were removed from the lower abdominal incision.The operation time,bleeding volume and hospitalization time were recorded.Analyze their clinical data and compare two sets of surgical time,blood loss,surgical results.Results:The operation was successfully completed in the 41 cases.The average operation time of the observation group and the control group were(113.7±12.6),(132.4±15.8)min,P<0.05.And the blood loss were(67.5±8.6),(109.4±7.1)ml,P<0.05.The average postoperative hospital stay were(4.8±1.3),(5.2±1.4)d,P>0.05,all patients were discharged with the catheter.Postoperative recurrence rate:11.76%,20.83%,P>0.05.All the patients successfully underwent the surgery,and no severe complications were observed during the perioperative period.Compared to group B,group A has better results in operation time,blood loss.Conclusions:Compared to retroperitioneal laparoscopic combined urethral resectoscopy nephroureterectomy,retroperitioneal laparoscopic radical nephroureterectomy has shorter operation time,less blood loss.It was practicable,safe and effective. |
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