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目的:探究后腹腔镜下肾输尿管切除术联合经尿道电凝与后腹腔镜下肾输尿管切除术联合经尿道电切在治疗上尿路尿路上皮癌的临床疗效差异。方法:选取2009年1月~2015年1月期间收治的108例上尿路尿路上皮癌患者为研究对象,采用随机数表法将患者分为电凝治疗组和电切治疗组各54例。电凝治疗组采用后腹腔镜下肾输尿管切除术联合经尿道电凝治疗;电切治疗组采用后腹腔镜下肾输尿管切除术联合经尿道电切治疗。对比两组患者的术中出血量、术后住院时间、手术时间和术后肿瘤复发率。结果:电凝治疗组患者的术中出血量、手术时间和住院时间分别为(79.7±15.7)ml、(108.2±17.1)min、(5.5±2.0)d,电切治疗组患者的术中出血量、手术时间和住院时间分别为(76.5±18.7)ml、(103.0±18.7)min、(7.1±2.2)d。两组患者的术中出血量和手术时间差异无统计学意义(P>0.05)。电凝治疗组患者的住院时间短于电切治疗组患者,差异有统计学意义(P<0.05)。电切治疗组54例患者有6例患者膀胱内肿瘤复发、10例膀胱外种植复发、10例肾盂肿瘤复发、6例输尿管肿瘤复发;电凝治疗组54例患者有2例患者膀胱内肿瘤复发、2例输尿管肿瘤复发。电切治疗组患者的术后肿瘤复发率显著高于电凝治疗组患者,差异有统计学意义(P<0.05)。结论:使用后腹腔镜下肾输尿管切除术联合经尿道电凝治疗上尿路尿路上皮癌患者能够显著降低术后肿瘤复发率,缩短住院时间,可以在临床上进一步推广和使用。
Objective: To investigate the clinical efficacy of retroperitoneal laparoscopic nephroureterectomy combined with transurethral electrocoagulation and retroperitoneal laparoscopic nephroureterectomy combined with transurethral resection in the treatment of upper urinary tract urothelial carcinoma. Methods: From January 2009 to January 2015, 108 cases of upper urinary tract urothelial carcinoma admitted from January 2009 to January 2015 were enrolled in this study. Patients were divided into electrocoagulation group and chemotherapy group by random number table . The electrocoagulation treatment group was treated by retroperitoneal laparoscopic nephroureterectomy combined with transurethral electrocoagulation. The electrosurgical treatment group was treated by laparoscopic radical nephroureterectomy combined with transurethral resection of the ureter. The amount of blood loss, postoperative hospital stay, operation time and postoperative tumor recurrence rate were compared between the two groups. Results: The intraoperative blood loss, operation time and hospital stay were (79.7 ± 15.7) ml, (108.2 ± 17.1) min and (5.5 ± 2.0) days in the electrocoagulation treatment group respectively. Intraoperative blood loss The volume, operation time and hospital stay were (76.5 ± 18.7) ml, (103.0 ± 18.7) min and (7.1 ± 2.2) d, respectively. There was no significant difference between the two groups in the amount of intraoperative blood loss and operation time (P> 0.05). Patients in the coagulation group had shorter hospital stays than those in the chemotherapy group, with significant differences (P <0.05). Among the 54 patients in the chemotherapy group, 6 patients had intravesical tumor recurrence, 10 patients had recurrent bladder transplantation, 10 had renal tumor recurrence, and 6 patients had ureteral tumor recurrence. In 54 patients with electrocoagulation therapy, 2 patients had intravesical tumor recurrence , 2 cases of ureteral tumor recurrence. The postoperative tumor recurrence rate of patients in the electrosurgical treatment group was significantly higher than that in the electrocoagulation treatment group, with significant difference (P <0.05). Conclusion: The use of retroperitoneal laparoscopic nephroureterectomy combined with transurethral electrocoagulation in the treatment of upper urinary tract urothelial carcinoma patients can significantly reduce the recurrence rate and shorten the length of hospital stay, which can be further popularized and used clinically.