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目的:比较后腹腔镜肾输尿管全切及膀胱袖状切除术与开放手术治疗上尿路移行细胞癌的临床疗效。方法:回顾分析我院2003年3月至2008年10月行后腹腔镜肾输尿管全切及膀胱袖状切除术治疗上尿路移行细胞癌47例,其中后腹腔镜手术26例(A组),传统的开放手术21例(B组)。对两组的临床疗效及随访结果等进行对比研究。结果:两组在发病年龄、性别、肿瘤大小、手术时间比较差异无显著性意义;A组术中出血量(98.2±28.5)ml、术后(33.6±12.4)h肠功能恢复、(43.5±12.5)h下床活动、应用止痛药(1.5±0.5)d、静脉应用抗生素(3.5±1.1)d、术后住院天数(6.5±1.5)d、(20.0±8.5)d恢复正常工作,明显优于B组,差异有统计学意义(P<0.05);A组并发症少于B组。两组平均随访(36.6±16.0)、(38.0±16.7)月,5年无复发生存率和总生存率比较无显著性差异(P>0.05)。结论:后腹腔镜肾输尿管切除及膀胱袖状切除术与开放手术相比,疗效相当,创伤小、痛苦少、术后恢复快、并发症少,可作为上尿路移行细胞癌的首选治疗方法。
Objective: To compare the clinical effects of retroperitoneal nephroureterectomy and bladder sleeve resection and open surgery for upper urinary tract transitional cell carcinoma. Methods: A retrospective analysis of our hospital from March 2003 to October 2008 after laparoscopic radical nephroureterectomy and bladder sleeve resection in the treatment of upper urinary tract transitional cell carcinoma in 47 cases, including 26 cases of retroperitoneal laparoscopic surgery (A group) The traditional open surgery in 21 cases (B group). The two groups of clinical efficacy and follow-up results were compared. Results: There was no significant difference in age, sex, tumor size and operation time between the two groups. The intraoperative blood loss (98.2 ± 28.5) ml in group A and the intestinal function in postoperative (33.6 ± 12.4) h were (43.5 ± (1.5 ± 0.5) d, intravenous antibiotics (3.5 ± 1.1) days, postoperative hospital stay (6.5 ± 1.5) days and (20.0 ± 8.5) days, respectively. In group B, the difference was statistically significant (P <0.05); group A less complications than group B. There was no significant difference between the two groups in mean follow-up (36.6 ± 16.0) and (38.0 ± 16.7) months and 5-year recurrence-free survival and overall survival (P> 0.05). Conclusions: Retroperitoneal laparoscopic nephroureterectomy and bladder sleeve resection have the same curative effect, less trauma, less pain and quick recovery after operation than those undergoing open surgery. It can be used as the first choice for the treatment of upper urinary tract transitional cell carcinoma .