Study On The Abscission Of UTUC Tumor Cells By Dissociating Kidney And Ureter With Laparoscopic

Objective:The incidence of intravesical recurrence(IVR)is very high in patients with upper tract urothelial carcinoma(UTUC)after laparoscopic nephroureterectomy(LNU)combined with lower abdominal oblique incision bladder cuff resection.The department of secretory urologist believes that free kidney and ureter will stretch or squeeze the tumor tissue under the high pneumoperitoneum pressure during the LNU operation of UTUC patients,causing a large number of urothelial tumor cells in the lumen to fall off,which may be implanted into the bladder.The purpose of this study was to analyze the changes of urinary tumor cells in the bladder before and during the operation by LNU combined with oblique incision bladder cuff resection in patients with UTUC,and to explore whether LNU surgical procedures increase the probability of tumor cells shed into the bladder.Methods:A total of 59 patients who were diagnosed as UTUC at the Second Hospital of Tianjin Medical University from January 2019 to January 2020 were collected in this experiment.Each research subject underwent LNU combined with oblique incision of the lower abdomen for bladder cuff-like resection.The patients were given the same amount of urine in the bladder before and during bladder cuff-like resection.An experimental method of fluorescent staining of acridine orange in exfoliated cells to find tumor cells in urine.59 cases of preoperative urine and intraoperative urine tumor cell changes were analyzed to explore the effect of LNU surgery on the UTUC tumor cell shedding into the bladder.In the statistical analysis,χ2 test was performed on the data of DNA ploidy analysis research results of urine exfoliated cells,and paired t test and correlation analysis were performed on the results of fluorescent staining of acridine orange in urine exfoliated cells.Results:32 urine samples of 59 UTUC patients underwent DNA ploidy analysis of urinary exfoliated cells.The results showed that 17 and 20 tumor-positive patients in the urine samples collected before and during the operation were P = 0.611 and 32 patient’s tumor location(ureteral cancer P = 1.000,renal pelvis cancer P = 0.715),tumor pathological grade(low grade P = 1.000,high grade P = 0.534),gender(male P = 0.325,female P = 1.000)and preoperative Hematuria(hematuria P = 1.000,hematuria P = 1.000)was analyzed,and there was no significant statistical difference.In addition,acridine orange fluorescence staining results of urine specimens from urine samples of 27 patients showed that the average content of tumor cells in urine before and during operation was 1.56 ± 1.739 and 2.37 ± 2.762,respectively,p = 0.147,ρ = 0.276,The patient’s tumor location(ureteral cancer P = 0.169,renal pelvis cancer P = 0.357),tumor pathological grade(low grade P = 0.115,high grade P = 0.816),gender(male P = 0.185,female P = 0.600)and surgery Pre-hematuria(hematuria P = 0.348,hematuria P = 0.197)was analyzed,and there was no significant statistical difference.The experimental results showed that there was no significant change in the amount of shed tumor cells in urine specimens before and during operation.Conclusions:There was no significant difference in the amount of tumor cells in the urine of patients with UTUC before and during the operation.Therefore,we believe that LNU did not increase the risk of tumor cells falling out into the bladder during the operation.