一体位机器人辅助腹腔镜与后腹腔镜肾输尿管切除术治疗上尿路尿路上皮癌的疗效比较

A comparison of the efficacy between single-position robot-assisted laparoscopic and retroperitoneal laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma

摘要

目的 探讨一体位机器人辅助腹腔镜肾输尿管切除术治疗上尿路尿路上皮癌（UTUC）的临床安全性和疗效。方法 回顾性研究兰州大学第二医院泌尿外科2020年12月-2023年8月接受一体位机器人辅助腹腔镜（RRNU组：35例）和后腹腔镜（LRNU组：101例）肾输尿管切除术的136例UTUC患者，比较两组患者的围手术期及安全性指标，采用Kaplan-Meier法比较两组患者的膀胱无复发生存率（IVRFS）、无复发生存率（RFS）、总体生存率（OS）。结果 两组患者的基线资料差异无统计学意义（P＞0.05），手术均顺利完成，无中转开放。RRNU组的术后总体并发症发生率[37.1%（13/35）vs.56.4%（57/101）]、术后住院时间[6（5，7）d vs.7（6，8）d]、引流管留置时间[3（2，4）d vs.4（3，5）d]等围手术期指标均优于LRNU组，差异具有统计学意义（P＜0.05），两种术式的安全性指标相似（P＞0.05），生存分析显示RRNU组患者的疗效[IVRFS（1年：92.1%，2年：85.2%）、RFS（1年：82.4%，2年：74.9%）、OS（1年：90.6%，2年：84.2%）]与LRNU组相似（P＞0.05）。结论 与后腹腔镜RNU手术相比，一体位RRNU治疗UTUC具有较高的安全性和较好的疗效，同时在降低术后并发症发生率、缩短住院时间等围手术期指标方面更具优势。

Abstract

Objective To explore the clinical safety and efficacy of a single-position robot-assisted radical nephroureterectomy (RRUN) in the treatment of upper tract urothelial carcinoma (UTUC). Methods A retrospective study was conducted on 136 UTUC patients who underwent RRUN (n=35) and laparoscopic radical nephroureterectomy (LRUN, n=101) in our hospital during Dec. 2020 and Aug. 2023. The perioperative and safety indicators of the two groups were compared. The intravesical recurrence-free survival (IVRFS), recurrence-free survival (RFS), and overall survival (OS) of the two groups were compared using Kaplan-Meier method. Results There were no significant differences in the baseline data between the two groups (P>0.05). All surgeries were successfully completed without conversion to open surgery. RRUN demonstrated superior perioperative outcomes compared to LRUN in overall postoperative complication rate [37.1% (13/35) vs. 56.4% (57/101)], postoperative hospital stay [6 (5, 7) days vs. 7 (6, 8) days], and catheter indwelling time [3 (2, 4) days vs. 4 (3, 5) days], with statistically significant differences (P<0.05). Safety indicators of both surgical approaches were similar (P>0.05). Survival analysis showed no significant difference in oncological outcomes between the two groups [IVRFS (1 year: 92.1%, 2 years: 85.2%), RFS (1 year: 82.4%, 2 years: 74.9%), OS (1 year: 90.6%, 2 years: 84.2%)] (P>0.05). Conclusion Compared with retroperitoneal LRUN, single-position RRUN for UTUC demonstrates comparable safety and oncological efficacy, while offering significant advantages in perioperative outcomes such as reducing postoperative complication rate and shortening hospital stay.

关键词

上尿路尿路上皮癌 / 机器人辅助 / 肾输尿管切除术 / 腹腔镜 / 一体位

Key words

upper tract urothelial carcinoma / robot-assisted / nephroureterectomy / laparoscope / single-position

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