关键词: 改良经腹入路全腹腔镜手术, 上尿路上皮癌, 单一体位

Abstract: Objective To observe the effect of modified transabdominal total laparoscopic surgery in patients with upper tract urothelial carcinoma (UTUC).〖WTHZ〗Methods〓〖WTBZ〗84 patients with UTUC were divided into improved group (n=43) and conventional group (n=41) according to different surgical methods.The modified group underwent modified transabdominal total laparoscopic surgery (modified single position transabdominal total laparoscopic nephroureterectomy + bladder sleeve resection).In the conventional group,laparoscopic nephrectomy was performed by retroperitoneal approach in the lateral decubitus position,and then ureterectomy + bladder sleeve resection was performed by oblique incision in the lower abdomen in the supine position.The perioperative condition,visual analogue scale (VAS) score at each time point after operation,postoperative complications and trauma response index before and after operation were compared between the two groups;The tumor recurrence and metastasis rate of the two groups at 1 year after operation were counted.Results The operations of 84 patients were successfully completed.The intraoperative blood loss and postoperative drainage in the modified group were (118.29±36.41) mL and (127.36±24.75) mL,respectively,which were lower than those in the conventional group (142.54±30.68) mL and (251.49±39.50) mL.The operation time,postoperative first exhaust time and hospitalization time were (107.35±15.62) min,(22.19±3.74) h and (7.32±0.58) d respectively,which were shorter than (139.57±21.09) min,(29.25±5.06) h and (9.68±0.62) d in the conventional group (P<0.05);The VAS scores of the modified group at 6 h,12 h,24 h and 48 h after operation were lower than those of the conventional group (P<0.05);The levels of serum IL-6 and CRP in the modified group at 12 h and 24 h after operation were (9.17±1.86) ng / L,(6.74±1.35) ng / L,(10.37±1.95) mg / L and (7.26±1.34) mg / L respectively,which were lower than those in the conventional group (14.20±3.04) ng / L,(9.36±2.17) ng / L,(15.46±2.69) mg / L and (10.72±1.82) mg / L (P<0.05);There was no difference in the incidence of postoperative complications between the modified group (9.30 %) and the conventional group (24.39 %) (P>0.05);There was no difference in the rate of tumor recurrence and metastasis between the two groups 1 year after operation(P>0.05). Conclusion Modified transabdominal total laparoscopic surgery for UTUC has the advantages of less bleeding,convenient operation,rapid postoperative recovery,less pain and less trauma.It has good application effect and high safety.   

Key words: modified transabdominal total laparoscopic surgery, upper tract urothelial carcinoma, single position