Boari膀胱肌瓣术在中下段输尿管癌患者保肾手术中的应用

摘要

目的：观察Boari膀胱肌瓣术在中下段输尿管癌患者保肾手术中的应用效果。方法选取2009年3月至2012年3月在我院接受手术的80例中下段输尿管癌患者为研究对象，按手术方式的不同分为对照组和观察组，各40例，对照组行输尿管癌根治术，观察组行Boari膀胱肌瓣术，术后均随访3年。观察2组患者术前和术后3个月肾功能、肿瘤标志物和炎症指标水平，比较2组患者远期预后的差别。结果2组患者手术前的肾功能指标无明显差别，手术后2组患者BUN、Scr、血尿素和血尿酸指标均较手术前升高，但对照组升高更为明显，差异具有统计学意义(P<0.05)；手术前2组患者肿瘤标志物CA19-9、Survivin和炎症指标WBC、NEC%、IL-6、hs-CRP水平无明显差别，手术后2组患者的水平均有所下降，但组间比较差异无统计学意义(P>0.05)；2组患者1年、2年和3年生存率差异无统计学意义(P>0.05)。结论对中下段输尿管癌患者保肾手术中采用Boari膀胱肌瓣术可在不影响肿瘤的根治和远期预后的前提下，有效维持患者的肾功能。%Objective To observe the effect of Boari bladder muscle flap surgery in nephron sparing surgery for patients with middle and lower ureteral carcinoma. Methods Totally 80 patients with middle and lower ureteral carcinoma underwent surgery in our hospital from March 2009 to March 2012 were selected and divided into the control group and the observation group,with 40 cases in each group. Patients of the control group were treated with ureteral carcinoma radical prostatectomy while patients of the observation group were treated with Boari bladder muscle flap surgery,and all of them were followed up for 3 years after operation. Observed the renal function,renal tumor markers and the level of inflammatory symptoms of the 2 groups before the operation and 3 months after the operation,and compared the long-term progno-sis of the 2 groups. Results There was no significant difference between the 2 groups in renal function index before operation. The level of BUN,Scr,blood urea and serum uric acid index in the 2 groups were all increased compared with those before operation,but the increase of the control group was significantly higher with statistically significant differences (P<0. 05). The tumor markers CA19-9, Survivin and in-flammatory marks WBC,NEC%,IL-6,hs-CRP had no significant difference before operation,and all the level of the 2 groups were decreased after operation,but there was still no difference between the 2 groups (P>0. 05). The survival rate 1 year,2 years and 3 years after operation also had no significant difference between the 2 groups (P>0. 05). Conclusion The use of Boari bladder muscle flap surgery in nephron sparing surgery for patients with middle and lower ureteral carcinoma can effectively maintain the renal function of patients without affecting the radical and long-term prognosis.