腹部小切口联合后腹腔镜术治疗肾盂癌的临床观察及预后影响因素分析

目的 研究腹部小切口联合后腹腔镜术治疗肾盂癌的临床效果,并分析可能影响其远期预后的相关因素.方法 选取2009年2月-2010年11月收治的78例肾盂癌患者,其中30例采用常规开放性根治性肾输尿管切除术治疗为对照组,48例采用腹部小切口联合后腹腔镜术治疗为观察组,比较两组手术结果和术后并发症发生情况,随访5年观察两组肿瘤复发转移和生存率情况,并分析观察组远期预后的可能影响因素.结果 两组手术均取得成功,但观察组术中出血量、术后肠功能恢复时间、住院时间较对照组低(P＜0.01).观察组术后并发症发生率低于对照组(P＜0.05).肿瘤直径≤2.5 cm、肿瘤细胞G1和G2级、国际抗癌联盟(UICC)病理分期T1和T2患者的5年生存率分别较肿瘤直径＞2.5 cm、肿瘤细胞G3级、UICC病理分期T3 ～ T4期患者高(P ＜0.05,P＜0.01).结论 腹部小切口联合后腹腔镜术具有创伤小、并发症少、出血量少等优点;肿瘤大小、细胞分级及病理分期是影响远期预后疗效的重要影响因素.

Clinical Observation of Abdominal Small Incision Combined with Retroperitoneal Laparoscopy in Treatment of Renal pelvic Carcinoma and Influencing Factors of Prognosis

Objective To study clinical effect of abdominal small incision combined with retroperitoneal laparoscopy in treatment of renal pelvic carcinoma,and possibly related factors influencing long-term prognosis.Methods A total of 78 patients with renal pelvic carcinoma treated during February 2009 and November 2010 were recruited in this study.The 30 patients with routine open radical nephro-ureterectomy were included in control group,while 48 patients with abdominal small incision combined with retroperitoneal laparoscopy were included in observation group.Operation results and incidence rate of postoperative complications were compared between the two groups.Conditions of tumor recurrence and metastasis and survival rate were observed during 5 years of follow-up.Possibly influencing factors of longterm prognosis were analyzed in observation group.Results Operations were successful in the two groups.Values of intraoperative blood loss volume,recovery time of postoperative intestinal function and length of stay in observation group were significantly lower than those in control group (P ＜ 0.05).Incidence rate of postoperative complications in observation group was significantly lower than that in control group (P ＜ 0.05).The 5-year survival rates of patients with tumor diameter equal or less than 2.5 cm,tumor cell grading G1-G2 and UICC pathological stage T1 and T2 were respectively higher than patients with tumor diameter more than 2.5 cm,tumor cell grading G3 and UICC pathological stage T3 and T4 (P ＜ 0.05,P ＜ 0.01).Conclusion Abdominal small incision combined with retroperitoneal laparoscopy has advantages such as less trauma,fewer incidence rate of complications and less blood loss.Tumor size,cell grading and pathological stage are the important factors influencing the long-term prognosis.