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目的:比较两种不同手术方式处理输尿管末端治疗上尿路肿瘤远期疗效。方法:采用回顾性研究我科后腹腔镜肾输尿管全长切除术治疗上尿路移行细胞癌的资料,对86例上尿路肿瘤术后患者的临床资料进行分析。A组:经尿道电切输尿管口53例,电切前先电灼患侧输尿管口;B组:开放手术行输尿管末端膀胱袖套状切除33例。比较两组术后膀胱癌发生率、局部复发率、远处转移率以及生存率等指标的差异。结果:经尿道电切输尿管口组患者术后再发膀胱癌19例(31.1%);开放手术行输尿管末端膀胱袖套状切除组患者术后再发膀胱癌10例(24.4%)。两组术后再发膀胱癌率(x2=0.550,P=0.458)和局部复发率(x2=0.057,P=0.811)比较差异无统计学意义。经尿道电切输尿管口组患者术后发生远处转移8例(13.1%),开放手术行输尿管末端膀胱袖套状切除组患者术后发生远处转移3例(7.3%);两组术后远处转移率比较差异无统计学意义(x2=0.360,P=0.549)。经尿道电切输尿管口组患者因肿瘤死亡20例,中位生存时间78个月;开放手术行输尿管末端膀胱袖套状切除组患者因肿瘤死亡18例,中位生存时间75个月。两组患者术后生存率比较差异无统计学意义(x2=1.296,P=0.255)。结论:经尿道电切输尿管口与开放手术行输尿管末端膀胱袖套状切除两种手术方法处理输尿管末端治疗上尿路肿瘤远期疗效相似。
Objective: To compare the long-term efficacy of two different surgical approaches for the treatment of upper urinary tract tumors at the distal ureter. Methods: The data of retrospective study of total laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma were retrospectively studied. The clinical data of 86 patients with upper urinary tract tumor were analyzed. Group A: transurethral resection of the ureter orifice in 53 cases, electrosurgical before electrocautery ipsilateral ureteral orifice; Group B: open surgery in the distal ureter sleeve cuff resection in 33 cases. The differences in the incidence of bladder cancer, local recurrence, distant metastasis and survival were compared between the two groups. Results: Twenty-nine patients (31.1%) had recurrent bladder cancer after transurethral resection of the ureteral orifice and 10 patients (24.4%) had recurrent bladder cancer after the operation. There were no significant differences in the rates of recurrent bladder cancer (x2 = 0.550, P = 0.458) and local recurrence (x2 = 0.057, P = 0.811) between the two groups. Transurethral electrovaporization of the ureteral orifice occurred in 8 patients (13.1%) after surgery, and in 3 cases (7.3%) of the distal ureteral catheter cuff-shaped resection group were treated by open surgery. Three patients (7.3% There was no significant difference in distant metastasis rate (x2 = 0.360, P = 0.549). Transurethral electrovaporization of the ureteral orifice in patients with tumor death in 20 patients, the median survival time of 78 months; open surgery in the distal cuff ureter cuff resection group of patients due to tumor death in 18 cases, the median survival time of 75 months. There was no significant difference in postoperative survival between the two groups (x2 = 1.296, P = 0.255). Conclusion: Transurethral electrovaporization of ureteral orifice and open surgery in the treatment of ureteral end cuff cuff surgery two methods of treatment of the distal ureteral cancer treatment of long-term efficacy of upper urinary tract similar.