| Objective: To explore the therapeutic efficacy and tumor safety of two common ureteral end treatment methods（bladder sleeve resection through small abdominal incision and transurethral resection of ureteral opening）in retroperitoneal laparoscopic radical nephrectomy for patients with upper urinary tract epithelial cancer（pathological stage ≤ T2）in our hospital,so as to provide relevant reference for the selection of clinical surgical diagnosis and treatment methods..Methods: The clinical data of 98 patients with upper urinary tract epithelial cancer with pathological stage ≤ T2 treated by our department from January 2018 to January 2021 were retrospectively analyzed,and the upper edge of sacroiliac joint was taken as the dividing line with reference to ureteral imaging,Upper urothelial carcinoma was divided into upper urothelial tumor（above the upper edge of sacroiliac joint,including renal pelvis tumor）group（48 cases）and lower upper urothelial tumor（below the upper edge of sacroiliac joint）（50 cases）.At the same time,according to the different surgical methods,the two groups were subdivided into abdominal incision group and electric resection group.In the upper urinary tract tumor group or the lower upper urinary tract tumor group,the preoperative data such as gender,BMI,tumor size and postoperative pathological stage of the patients in the abdominal incision group and the electro-resection group were statistically analyzed.There was no significant difference in the preoperative statistics between the two groups.Then,the operation time,postoperative indwelling drainage tube time,postoperative indwelling catheter time,postoperative discharge time and tumor recurrence within 6months after operation,to evaluate the efficacy of the operation and the safety of short-term tumor after operation,so as to provide reference for the selection of ureteral end treatment in radical resection of upper urinary tract epithelial cancer at different positions.Results: All the patients in the four groups successfully completed the operation without conversion to open surgery.There were no severe complications such as shock and death during the perioperative period.All patients were discharged smoothly,and the postoperative bladder perfusion was completed before discharge.At discharge,the patient had removed the whole-body drainage tube and catheter,the incision healed well,and there was no urinary incontinence and other related discomfort after removing the catheter.After discharge,the patients continued to perform regular perfusion and cystoscopy according to the bladder perfusion scheme（for at least one year）,and were followed up for half a year.In the upper ureteral tumor group,the operation time of group A was 131.21 ± 20.21 min,and that of group B was 172.39 ± 29.54 min.There was significant statistical difference between the two groups（P<0.001）.Intraoperative blood loss was 102.40 ± 35.27 ml in group A and158.70 ± 33.48 ml in group B,P<0.05;Comparison of postoperative exhaust time:the median exhaust time in group A was 2 days;The median exhaust time in group B was 3 days,P<0.05;Lower ureteral tumor group;The operation time in group C was133.18 ± 19.49 min and that in group D was 193.18 ± 42.27 min,P < 0.05.Intraoperative blood loss was 118.18 ± 17.90 ml in group C and 194.29 ± 17.89 ml in group D,P<0.05;The median time of postoperative exhaust was 2 days in group C and 3 days in group D,P<0.05;Group A and group B,group C and group D were compared respectively.The comparison results showed that there was no statistical significance in the following aspects: the time of postoperative hospitalization,the time of postoperative catheter removal,the time of postoperative drainage tube retention and postoperative exhaust,and the tumor recurrence within half a year of postoperative follow-up（P>0.05）.Conclusion: For upper urinary tract epithelial carcinoma with pathological stage≤ T2,no matter where the tumor is located,the electric resection group and the abdominal incision group have the same oncological safety.There is no obvious abnormality in the probability of postoperative bladder tumor recurrence.and there is no obvious abnormality in the length of hospital,the removal time of systemic drainage tube and urinary catheter,and the short-term postoperative recurrence rate in the bladder.However,compared with the abdominal incision group,the electric resection group has the advantages of shorter operation time,less intraoperative bleeding and earlier postoperative exhaust time.Therefore,for the upper urinary tract epithelial carcinoma with pathological stage ≤ T2,the tumor location does not affect the choice of ureteral end treatment in retroperitoneal laparoscopy,In retroperitoneal laparoscopic radical surgery for UTUC,transurethral resection of ureteral orifice is more recommended than bladder sleeve resection through abdominal incision. |
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