腹腔镜脐尿管癌手术切除的临床研究

发布时间：2018-07-05 01:28

本文选题：脐尿管癌 + 手术　；参考：《山东大学》2017年硕士论文

【摘要】：目的:介绍腹腔镜脐尿管癌手术切除的可行性及临床疗效。材料、方法:回顾性分析山东大学附属省立医院自2008年1月～2014年1月,对21例平均年龄53±12.6岁(23～76岁),肿瘤最大径平均4.0±1.5cm(2.1～7.4cm)的脐尿管癌患者采用开放式或腹腔镜切除术。其中2例Sheldon分期Ⅱ期,其余19例属Sheldon分期Ⅲ期,均为ⅢA期。手术切除范围包括:脐尿管所有残留结构包含与其相连的腹横筋膜和腹膜,膀胱顶壁(脐尿管肿物及其周围2cm的正常膀胱壁)。记录手术时间、出血量、术中是否输血、手术后病理结果、拔除腹腔引流管时间、拔除导尿管时间、围手术期相关并发症及住院天数。17例术后行GC方案化疗3个疗程。术后患者定期复查胸部、全腹部及盆腔强化CT、膀胱镜并随访复发情况及生存时间,中位随访时间36个月(5～61个月)。结果:本组21例患者中6例行开放性手术。其余15例均行腹腔镜手术,无中转开放手术。开放手术组平均手术时间98.3±26.4分钟(60～130分钟),手术中平均估计出血量60±20ml(50～100ml),术中均无输血,腹腔引流管平均留置8.5±4.0天(5～14天),术后平均留置导尿管10.5±3.7天(6～13天),均未出现尿漏,术后2～3天可进流质饮食,平均住院时间11.5±3.7天(7～14天)。腹腔镜手术组平均手术时间100.7±30.6分钟(50～160分钟),手术中平均估计出血量49.3±29.4ml(20～100ml),术中均无输血,腹腔引流管平均留置时间6.5±2.9天(3～13天),术后平均留置导尿管10.8±3.8天(6～18天),均未出现尿漏,术后2～3天可进流质饮食,平均住院时间11.8±3.8天(7～19天)。术后病理结果:脐尿管非囊性腺癌19例(19/21),其中:粘液型腺癌11例(11/19),肠型腺癌6例(6/19),肠型腺癌及粘液型腺癌混合者2例(2/19)。另有粘液囊腺癌1例,混合癌1例。病理切缘均为阴性,由于术前影像学检查未提示存在盆腔淋巴结转移,且肿瘤均未累及腹壁、腹膜,故21例患者均未行淋巴结清扫或脐部切除。术中及术后并发症情况:1名患者术后7天诉左小腿疼痛,急查D二聚体(D-dimer)5.85ng/ml,双下肢血管彩超示左小腿肌间静脉血栓,给予抗凝治疗后好转,余患者均恢复顺利。中位随访时间36个月(5～61个月),其中1年总体生存率(overall survival,OS)为 76.19%(16/21),疾病特异性生存率(disease specific survival,DSS)为85.7%(18/21),2 年 OS 为 66.67%(14/21),DSS 为 81.0%(17/21),3 年OS 为57.14%(12/21),DSS 为 81.0%(17/21)。结论:脐尿管癌临床发病率低,病因尚未明确,其最常见病理类型为腺癌。脐尿管癌恶性程度高,预后较差,但常由于该疾病症状隐匿使得早期发现、诊断变得困难。常见首发症状多为肉眼血尿或尿频、尿急、尿痛等排尿刺激征,也可见耻骨上疼痛、肉眼粘液性尿,极少数患者因可触及的孤立性腹部包块就诊。确诊时多数患者已经出现了膀胱浸润。针对脐尿管癌的治疗目前尚无统一的指南,手术治疗是脐尿管癌首选治疗办法,腹腔镜膀胱部分切除手术(laparoscopic partial cystectomy,LPC)与开放手术或膀胱根治性切除手术相比预后相当。LPC用于治疗脐尿管癌具有围术期短、失血少、刀口美观、创伤小、术后并发症少等优势,手术中应注意防止肿瘤扩散。肿瘤的分期早及术后病理切缘阴性的脐尿管癌预后相对较好。而淋巴结清扫和其他辅助治疗对于生存率的影响尚不明确。相对于开放手术,LPC是一种更加安全,值得推广的治疗方法。
[Abstract]:Objective: to introduce the feasibility and clinical effect of laparoscopic urachal carcinoma resection. Materials and methods: a retrospective analysis of 21 cases of urachal cancer with an average age of 53 + 12.6 years (23~76 years) and an average of 4 + 1.5cm (2.1 ~ 7.4CM) 1.5cm (2.1 ~ 7.4CM) with an open or laparoscopy from January 2008 to January 2014 in the affiliated Provincial Hospital of the Affiliated Hospital of Shandong University was reviewed. Excision. 2 cases of Sheldon staging stage II, the other 19 cases were stage III of Sheldon stage III, stage III A. The surgical excision range includes: all residual structures of urachus include the abdominal transverse fascia and peritoneum, the top wall of the bladder (urachal mass and the normal bladder wall around 2cm). Postoperative pathological results, extraction of abdominal drainage tube time, extraction of catheter time, perioperative complications and the number of days of hospitalization.17 after 3 courses of chemotherapy GC regimen. Postoperative patients regularly review the chest, abdominal and pelvic enhanced CT, cystoscopy and follow-up and survival time, median follow-up time of 36 months (5~61 months). Fruit: 6 of the 21 patients in this group were operated on open surgery. The remaining 15 cases were performed laparoscopy without open operation. The average operation time of the open operation group was 98.3 + 26.4 minutes (60~130 minutes). The average estimated bleeding was 60 + 20ml (50 ~ 100ml) during the operation. There was no blood transfusion during the operation, and the average retention of the abdominal drainage tube was 8.5 + 4 days (5~14 days), and the postoperative level was flat. The urethral catheter was retained for 10.5 + 3.7 days (6~13 days), and no urinary leakage was found. The average hospitalization time was 11.5 + 3.7 days (7~14 days) 2~3 days after the operation. The average operation time of the laparoscopic operation group was 100.7 + 30.6 minutes (50~160 minutes). The average estimated bleeding was 49.3 29.4ml (20 ~ 100ml) during the operation. There was no blood transfusion in the operation, and Guan Ping was drained in the abdominal cavity. The average retention time was 6.5 + 2.9 days (3~13 days). The average indwelling catheter was 10.8 + 3.8 days (6~18 days) after the operation. No urinary leakage was found. The intake of the fluid was not found on 2~3 days after the operation. The average hospitalization time was 11.8 + 3.8 days (7~19 days). The postoperative pathological results were 19 (19/21) of urachal non cystic adenocarcinoma, including mucinous adenocarcinoma 11 cases (11/19) and intestinal adenocarcinoma 6 cases (6/19). There were 2 cases of intestinal adenocarcinoma and mucous adenocarcinoma (2/19). There were 1 cases of mucinous cystadenocarcinoma and 1 cases of mixed carcinoma. The pathological margins were all negative. There were no pelvic lymph node metastases in the preoperative imaging examination, and no abdominal wall and peritoneum were involved in all 21 patients. Intraoperative and postoperative complications were not performed. 7 days after operation, 1 patients complained of left calf pain, D two polymer (D-dimer) 5.85ng/ml, double leg blood vessel color Doppler ultrasound in left calf intermuscular venous thrombosis, after anticoagulation treatment improved, the remaining patients recovered smoothly. The median follow-up time was 36 months (5~61 months), and the total survival rate of 1 years (overall survival, OS) was 76.19% (16/21), disease specificity. The survival rate (disease specific survival, DSS) was 85.7% (18/21), OS was 66.67% (14/21), DSS was 81% (17/21), 3 year OS was 57.14% (12/21) and DSS was 81%. Conclusion: the clinical incidence of urachus cancer is low, the etiology is not clear, the most common pathological type is adenocarcinoma. Urachus cancer is highly malignant and poor prognosis, but often due to this Insidious symptoms of the disease make it difficult to find early diagnosis. The common onset symptoms are mostly hematuria or frequency of urine, urination, urine pain and other urination irritation, as well as suprapubic pain, mucous urine, and very few patients with palpable isolated abdominal mass. Most patients have had bladder infiltration at the time of diagnosis. There are no unified guidelines for the treatment of carcinoma of the tube. Surgical treatment is the first choice for urachal carcinoma. Laparoscopic partial cystectomy (laparoscopic partial cystectomy, LPC) is quite.LPC compared to open surgery or radical resection of the bladder for the treatment of umbilical cord carcinoma with short perioperative period, less bleeding, beautiful knife mouth and trauma. Small, less postoperative complications, attention should be paid to the prevention of tumor diffusion. The prognosis of urachus cancer with early stage and postoperative pathological margin is relatively good. The effect of lymph node dissection and other adjuvant therapy on the survival rate is not clear. Compared with open surgery, LPC is a safer and worth popularizing treatment.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.1

【相似文献】