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상부 요상피암에 대한 변형된 앙와위 손을 이용한 복강경 신요관적출술
백성현(Sung Hyun Paick),박형근(Hyoung Keun Park),노용수(Yong Soo Lho),추관엽(Gwoan Youb Choo),김형곤(Hyeong Gon Kim) 대한비뇨기종양학회 2011 대한비뇨기종양학회지 Vol.9 No.3
Purpose: We developed modified supine position hand-assisted laparoscopic nephroureterectomy (MS-HALNU) without position change during the operation in patients with upper urinary tract urothelial cell carcinoma. So, we report these results. Materials and Methods: Twenty two patients (including three with metastatic cancer) with upper urinary tract urothelial cell carcinoma underwent a unilateral MS-HALNU. Patient’s position was supine but operation side was elevated 30 degree with soft pad. An 8cm Gibson incision on the operation side was performed for a distal ureterectomy and bladder cuff excision, which were carried out as open surgery. The nephroureterectomy was followed without position change using hand-assisted technique via the same incision and two additional 10mm ports. Results: All 22 MS-HALNUs were successfully completed without open conversion; there were no major complications. The average operation time was 257 minutes and the average estimated blood loss was 173ml. The average interval to resuming oral intake was 2.6 days and the average hospital stay was 8.6 days. The average follow-up period was 30.1 months. In 15 localized cases (below T2), no recurrence occurred. However, in four T3 cases, 3 recurrences (2 bladder) occurred even with adjuvant chemotherapy. In 3 palliative cases, all patients died due to disease progression. Conclusions: MS-HALNU is easy, safe and effective treatment for patients with upper urinary tract urothelial cell carcinoma.
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