To determine the efficacy of robot-assisted radical cystectomy (RARC) in improving the postoperative outcomes of patients with bladder cancer. A comprehensive search was conducted using multiple electronic databases to identify randomized controlled trials (RCTs) evaluating RARC in adult patients with bladder cancer. Quantitative pooling of the data was performed using the Review Manager software 5.4.1. A total of 13 RCTs reporting 1043 patients were included. RARC significantly reduced the risk of wound and thromboembolism complications (relative risk [RR], 0.38; 95% confidence interval [CI], 0.22–0.64; P = 0.00003, I2 = 0%; RR, 0.50; 95% CI, 0.28–0.89; P = 0.02, I2 = 39%). RARC also led to a reduction in estimated blood loss (weighted mean difference [WMD] −310.40; 95% CI, 419.41 to −201.38; P < 0.00001, I2 = 88%], transfusion rate (RR, 0.54; 95% CI, 0.42–0.68; P < 0.00001, I2 = 0%) and units of blood transfused (WMD, −1.51; 95% CI, −2.10 to 0.93; P < 0.00001, I2 = 0%). However, RARC needs a longer operating time (WMD, 76.99; 95% CI, 42.71–111.27; P < 0.00001, I2 = 94%). There was no significant difference in the overall recurrence rate (RR, 0.96; 95% CI, 0.76–1.21; p = 0.73), different time periods, and locations between the intervention and control arms. This systematic review and meta-analysis showed that oncological outcomes were comparable between patients who underwent RARC and those who underwent ORC or LRC. RARC is a safe and effective minimally invasive surgery that reduces blood loss, transfusion rates, and thromboembolic complications in patients with bladder cancer.

IntroductionKidney transplant recipients (KTRs) are at a higher risk of severe coronavirus disease (COVID-19) because of their immunocompromised status. However, the effect of allograft function on the prognosis of severe COVID-19 in KTRs is unclear. In this study, we aimed to analyze the correlation between pre-infection allograft function and the prognosis of severe COVID-19 in KTRs.MethodsThis retrospective cohort study included 82 patients who underwent kidney transplantation at the Sichuan Provincial Peoples Hospital between October 1, 2014 and December 1, 2022 and were diagnosed with severe COVID-19. The patients were divided into decreased eGFR and normal eGFR groups based on the allograft function before COVID-19 diagnosis (n=32 [decreased eGFR group], mean age: 43.00 years; n=50 [normal eGFR group, mean age: 41.88 years). We performed logistic regression analysis to identify risk factors for death in patients with severe COVID-19. The nomogram was used to visualize the logistic regression model results.ResultsThe mortality rate of KTRs with pre-infection allograft function insufficiency in the decreased eGFR group was significantly higher than that of KTRs in the normal eGFR group (31.25% [10/32] vs. 8.00% [4/50], P=0.006). Pre-infection allograft function insufficiency (OR=6.96, 95% CI: 1.4633.18, P=0.015) and maintenance of a mycophenolic acid dose >1500 mg/day before infection (OR=7.59, 95% CI: 1.0853.20, P=0.041) were independent risk factors, and the use of nirmatrelvir/ritonavir before severe COVID-19 (OR=0.15, 95% CI: 0.030.72, P=0.018) was a protective factor against death in severe COVID-19.ConclusionsPre-infection allograft function is a good predictor of death in patients with severe COVID-19. Allograft function was improved after treatment for severe COVID-19, which was not observed in patients with non-severe COVID-19.

肾移植是治疗慢性终末期肾脏疾病的有效手段,随着外科手术技术的提升、免疫抑制药物的优化以及移植后监测手段的改进,移植肾的存活率已经大为提高,1 年和 5 年的患者生存率分别为 95.4％和 88.1％[1].肠道菌群在各种疾病的病理生理及治疗,扮演着一个重要的角色.在健康人中存在着成千上万个微生物,它们生活在人体的各个地方,包括皮肤、口腔、胃肠道以及泌尿生殖道等,并以共生的方式相互协作、相互影响[2].目前研究发现,肾移植术后受者的肠道菌群有着明显的改变,这些差异可能对受者的预后产生重要的影响.本篇综述主要概述肠道菌群在健康人体的作用,然后讨论了肾移植术后微生物变化及其对免疫抑制剂和术后常见并发症(如排斥反应、感染、腹泻等)的影响.最后,总结了当前针对微生物的治疗方法.

Providing universal access to high-cost medications like anticancer drugs is not an easy feat. Although basic medical insurance has covered over 95% of China's population since 2012, reimbursement for high-priced medicines is limited. In 2015, the Chinese government proposed establishing an open and transparent price negotiation mechanism for some patented and expensive drugs, where oncology was among the prioritized areas. In 2016, three drugs (gefitinib, icotinib, and tenofovir disoprox) underwent negotiation with the government, eventually reducing their prices by over 50% so that they could be prioritized during reimbursement processes. Focusing on anticancer medicines, this study comprehensively summarizes the progress in drug price and national reimbursement negotiation in China. Furthermore, we investigated the changes and development regarding negotiated anticancer medicines from quantity negotiated, classification, indication coverage, utilization, and procurement spending. Our findings could provide a reference for follow-up negotiations and reimbursement policies for high-value anticancer medications in other countries. From 2016 to 2021, 82 anticancer medicines were newly incorporated into the national reimbursement drug list (NRDL) via 6 rounds of negotiation. The majority of these were innovative pharmaceutics (ie, protein kinase inhibitors (28) and monoclonal antibodies (13)). Drug pricing and national reimbursement negotiation led to a marked decrease in prices and a sharp increase in the utilization of negotiated anticancer medicines. Following negotiations, the defined daily doses (DDDs) of innovative anticancer medicines experienced remarkable growth. Their proportion in total anticancer drugs DDDs also increased from 3.4% in 2014 to 20.9% in 2019. However, although drug prices decreased substantially after the negotiations, insurance spending still showed an upward trend owing to the significant increase in utilization. This calls for the government to carefully monitor the rational use of these expensive medicines and explore innovative payment models.

1 临床资料 患者,女,34 岁,因"发现血肌酐升高 1+年,持续腹膜透析治疗10 个月"于2020 年9 月17 日入院. 患者1+年前于外院体检发现血肌酐升高,约800+ μmol/L,后复查血肌酐进行性升高,行右股静脉置管透析治疗2个月及腹膜透析治疗 10 个月(每日 3 次).

Graft-derived cell-free DNA (GcfDNA) is a promising non-invasive biomarker for detecting allograft injury. In this study, we aimed to evaluate the efficacy of programmed monitoring of GcfDNA for identifying BK polyomavirus-associated nephropathy (BKPyVAN) in kidney transplant recipients. We recruited 158 kidney transplant recipients between November 2020 and December 2021. Plasma GcfDNA was collected on the tenth day, first month, third month, and sixth month for programmed monitoring and one day before biopsy. ΔGcfDNA (cp/mL) was obtained by subtracting the baseline GcfDNA (cp/mL) from GcfDNA (cp/mL) of the latest programmed monitoring before biopsy. The receiver operating characteristic curve showed the diagnostic performance of GcfDNA (cp/mL) at biopsy time and an optimal area under the curve (AUC) of 0.68 in distinguishing pathologically proven BKPyVAN from pathologically unconfirmed BKPyVAN. In contrast, ΔGcfDNA (cp/mL) had a sensitivity and specificity of 80% and 84.6%, respectively, and an AUC of 0.83. When distinguishing clinically diagnosed BKPyVAN from clinical excluded BKPyVAN, the AUC of GcfDNA (cp/mL) was 0.59 at biopsy time, and ΔGcfDNA (cp/mL) had a sensitivity and specificity of 81.0% and 76.5%, respectively, and an AUC of 0.81. Plasma ΔGcfDNA (cp/mL) was not significantly different between TCMR [0.15 (0.08, 0.24) cp/mL] and pathologically proven BKPyVAN[0.34 (0.20, 0.49) cp/mL]. In conclusion, we recommend programmed monitoring of plasma GcfDNA levels after a kidney transplant. Based on our findings from the programmed monitoring, we have developed a novel algorithm that shows promising results in identifying and predicting BKPyVAN.

OBJECTIVE:To investigate the association between graft-derived cell-free DNA and pretransplantation clinical variables, and to determine whether the former could be used as a novel biomarker to predict renal function.METHODS:A total of 87 recipients who underwent primary kidney transplantation were recruited to the study. For each recipient, 10 mL peripheral blood was collected on days 1, 7, 14-20, and 30-45 after transplantation. The fractional abundance of graft-derived cell-free DNA was determined using droplet digital polymerase chain reaction.RESULTS:For most recipients, graft-derived cell-free DNA fraction values were significantly elevated on the first day after transplantation, followed by a rapid decline, and reaching baseline values of graft-derived cell-free DNA fraction in the range of <1% at 7 days. Statistical analysis showed that longer cold ischemia time was significantly associated with higher graft-derived cell-free DNA fraction values (P = 0.02). Moreover, we also found that graft-derived cell-free DNA fraction values among recipients with delayed graft function were significantly higher than those of recipients without delayed graft function on the first day after transplantation. Kaplan-Meier analysis showed that recipients who had a graft-derived cell-free DNA fraction value of <1% at 7 days had a significantly lower probability of an estimated glomerular filtration rate ≤60 mL/min/1.73 m2 at 90 days. Using a random forest regression model, the predicted values of estimated glomerular filtration rate at 90 days were almost the same as the actual values.CONCLUSIONS:Our findings suggest that graft-derived cell-free DNA might be used as a novel biomarker to predict delayed graft function and renal function.

目的 初步探讨在心死亡捐献供肾(donation after cardiac death,DCD)和亲属捐献供肾(living donor kidney,LDK)移植术患者行超声、彩色超声多普勒及移植肾超声造影(contrast-enhanced ultrasonography,CEUS)检查结果的特征及预测价值.方法 选取2017年12月-2020年6月于四川省医学科学院·四川省人民医院器官移植中心行同种异体肾移植术患者,收集发生DGF组患者和移植肾功能恢复正常组(immediate graft function,IGF)的移植肾动脉阻力指数、皮质时间差、皮椎时间差、锥体峰值时间、皮质峰值强度和冷缺血时间等对肾移植术后早期发生DGF的预测的可行性.结果 在本次观察性研究期间,共有60例同种异体肾移植患者满足观察性研究纳入标准,其中术后发生DGF的患者共21例.联合移植肾主肾动脉阻力指数、移植肾皮质时间差、移植肾锥体峰值时间、移植肾皮质造影峰值强度、皮质锥体到达时间差和冷缺血时间6个指标,经过logistic回归得"复合指标值"计算式为(3.471×主肾动脉阻力指数+0.157×皮质时间差T1+0.120×皮锥时间差-0.105×皮质峰值强度+0.005×锥体峰值时间+0.550×冷缺血时间)."复合指标值"ROC曲线下面积为0.901(P<0.001),"复合指标值"诊断95％可信区间分别为(0.822,0.978),"复合指标值"的诊断临界值为8.8158,灵敏度为85.70％,特异度为84.62％,阳性预测值为72％,阴性预测值为91.42％,阳性似然比为4.77,阴性似然比0.174.此外,本研究发现早期1例移植肾周巨大血肿,1例移植肾动脉狭窄,2例移植肾排斥.结论 本研究发现联合移植肾主肾动脉动力指数、移植肾皮质时间差、移植肾皮质造影峰值强度、移植肾皮质锥体造影达到时间差、移植肾冷缺血时间联合可早期及时预测发现移植肾功能恢复延迟,有较高的灵敏度和特异度.本次研究还发现CEUS对发现移植肾早期并发症有较大诊断价值,可及时发现移植肾周血肿、移植肾动脉狭窄、移植肾急性排斥等.

目的 供体来源的cfDNA(graft-derived cell-free DNA,GcfDNA)作为一种有前途的无创生物标志物,一系列研究已证明其在检测移植排斥反应中的应用价值.然而,在肾移植后,尚无关于程序性检测GcfDNA的报道.随访期监测GcfDNA是否能指导临床工作,尚不得知.方法 前瞻性采集了亲体肾移植和尸体肾移植受者术后第10天(D10)、第1个月(M1)、第3个月(M3)以及第6个月(M6)的GcfDNA拷贝数和百分比,并同期收集受者的临床资料,以作队列研究.结果 共纳入87例受者,在D10的GcfDNA拷贝数为0.70 cp/ml,显著高于M1的0.40 cp/ml,GcfDNA百分比在M1为0.5％,显著高于M3的0.3％,但肌酐和肾小球滤过率在不同的时间点均无显著性差异.组间比较显示,亲体移植组的GcfDNA拷贝数在D10显著低于尸体移植组(0.45 cp/ml比0.90 cp/ml,P<0.05).而两组受者的GcfDNA百分比在D10无显著性差异.将GcfDNA拷贝数和百分比与血清肌酐做回归分析,显示两者呈非线性相关.结论 与肌酐或病理活检相比,GcfDNA拷贝数和GcfDNA百分比可作为评价肾功能的独立指标,同时GcfDNA水平与病理活检结果保持一致.缺血/再灌注损伤对GcfDNA的影响可持续到10 d以上,建议程序性检测在术后10 d启动.

Efforts at finding potential biomarkers of tolerance after kidney transplantation have been hindered by limited sample size, as well as the complicated mechanisms underlying tolerance and the potential risk of rejection after immunosuppressant withdrawal. In this work, three different publicly available genome-wide expression data sets of peripheral blood lymphocyte (PBL) from 63 tolerant patients were used to compare 14 different machine learning models for their ability to predict spontaneous kidney graft tolerance. We found that the Best Subset Selection (BSS) regression approach was the most powerful with a sensitivity of 91.7% and a specificity of 93.8% in the test group, and a specificity of 86.1% and a sensitivity of 80% in the validation group. A feature set with five genes (HLA-DOA, TCL1A, EBF1, CD79B, and PNOC) was identified using the BSS model. EBF1 downregulation was also an independent factor predictive of graft rejection and graft loss. An AUC value of 84.4% was achieved using the two-gene signature (EBF1 and HLA-DOA) as an input to our classifier. Overall, our systematic machine learning exploration suggests novel biological targets that might affect tolerance to renal allografts, and provides clinical insights that can potentially guide patient selection for immunosuppressant withdrawal.

Background: It has been reported that donor derived cell-free DNA(dd-cfDNA) accounts for less than 1.2% of total cell free DNA in stable kidney allograft recipients, and dd-cfDNA may be a non-invasive biomarker of acute rejection. However, the kinetics of plasma dd-cfDNA level is still unclear, which hinders the further application of dd-cfDNA in kidney transplantation (KTx). The purpose of this study was to explore the correlation between plasma dd-cfDNA and delayed graft function(DGF） and pulmonary infection after KTx, and to explore the diagnostic value of dd-cfDNA in DGF. In addition, we tried to find out the factors related to the rebound of dd-cfDNA level. Methods: A total of 183 kidney transplant recipients were enrolled in this study. Peripheral blood samples (10ml) were collected on the 1st, 7th, 14th and 21st day after KTx, and 546 plasma samples were collected. Droplet digital PCR (DDPCR) was used to detect the level of dd-cfDNA(%) and Mann Whitney U test was used to analyze the relationship between dd-cfDNA level and DGF and pulmonary infection. Logistic binary regression analysis was used to analyze the clinical factors related to the increase of dd-cfDNA. Results: There was no significant difference between DGF group and non-DGF group of dd-cfDNA level (P > 0.05). The mean value of dd-cfDNA on day 1 (6.97%) was significantly higher than that on day 7 (1.17%), day 14 (1.09%) and day 21 (1.18%). Logistic binary regression analysis was performed for dd-cfDNA level rebound group and non-rebound group. Pulmonary infection (OR = 2.11, P = 0.028) and DGF (OR = 1.37, P = 0.42) were significantly correlated with rebound of dd-cfDNA. At the same time, on the 1st, 7th and 14th day after KTx, the levels of dd-cfDNA in pulmonary infection group was significantly higher than non-infection group (P < 0.05). Conclusion: Our results indicate that dd-cfDNA (%) can’t be used as a biomarker for predicting DGF. The rebound of plasma dd-cfDNA (%) level was significantly correlated with the presence of pulmonary infection. However, further confirmatory studies are necessary.

目的 评估终末期肾病丙型肝炎病毒(hepatitis C virus,HCV)患者接受肾移植手术、接受HCV IgG抗体(+)供肾及HCV感染供肾患者术后使用直接抗病毒药物(direct antiviral drugs,DAAs)的安全性及有效性.方法 回顾性纳入12例患者,其中9例为感染HCV接受肾移植手术的患者,1例为接受HCV IgG(+)供肾且术后口服索非布韦+维帕他韦抗病毒治疗,2例为接受6 a型HCV感染供肾的患者,术后口服索非布韦+维帕他韦抗病毒治疗.所有患者治疗期间定期复查血转氨酶、血清肌酐、药物浓度及HCV RNA复制量等相关数据来评估DAAs的疗效和安全性.结果 HCV感染患者接受肾移植手术后均获得持续性病毒学应答(sustained virological response,SVR),接受HCV IgG抗体(+)供肾患者术后HCV RNA及HCV IgG未出现阳性表达,接受HCV感染肾脏患者,术后复查提示HCV IgG阳性表达,截至随访至12周,HCV RNA持续阴性.除1例患者治疗期间出现肺部感染,其余患者随访期间血肌酐、药物浓度水平稳定,转氨酶水平较治疗前下降,1例患者不良反应为头晕.结论 丙肝患者接受肾移植手术后使用DAAs在严密检测下是安全可靠的,本文结果显示在有效的抗病毒治疗前提下接受HCV IgG(+)供肾及HCV感染供肾可能是安全的.

目的:探讨腹腔镜下肾切取联合自体肾移植术治疗复杂医源性输尿管缺损的应用.方法:回顾性分析腹腔镜下肾切取联合自体肾移植术治疗复杂医源性输尿管缺损患者围手术期及随访资料.结果:2例患者均经腹膜腔手术切取肾脏并经同侧下腹部Gibson切口取出,行工作台修整肾脏后经同一切口延长后完成自体肾移植手术均获得成功,2例患者手术时间分别为265 min和325 min,估计手术失血量分别为50 ml和100ml,肾热缺血时间分别为2 min和3 min,无术中及术后输血,无术后尿瘘等并发症.术后1周血清肌酐较术前明显好转.随访2～30个月,患者移植肾功能良好,肾功能稳定,无肾积水及结石复发等.结论:腹腔镜肾切取联合自体肾移植术治疗复杂医源性输尿管缺损有效,创伤小,可在急诊环境下安全实施.而熟练的腹腔镜技术、肾移植技术和谨慎的围手术期管理是该术式安全实施的重要保障.

患者女性, 32 岁,因"取节育环检查发现膀胱占位1 月"于2016 年10月26 日入院. 我院门诊 B 超提示:膀胱内可见一大小6.4 cm ×4.8 cm的不均质回声团,其内可见血流信号. CT 检查提示:膀胱内右侧壁可见软组织密度影,约7.1 cm ×6.6 cm,密度均匀,轻度强化,肿块紧贴的膀胱右后壁稍增厚,考虑膀胱占位.肿瘤位于膀胱右侧壁,双肾无积水,膀胱周围间隙清楚,淋巴结无肿大.入院诊断:膀胱肿瘤. 积极完善术前评估后,第一次手术在腰麻下行经尿道膀胱肿瘤电切活检术,术后病理结果提示:免疫表型 CK ( -) , a -SMA ( +),Desmin( +),S-100( -),b-Catemin( -) ,Ki-6阳性率约1％,送检为平滑肌组织. 于1 周后再次在腰麻下行经尿道钬激光膀胱肿瘤剜除术 +右侧输尿管支架管置入术.术中见:膀胱右侧壁可见一大小约7cm的包膜完整的突入膀胱腔内的新生物,其表面可见丰富的血管,基地宽约3cm,基底周围黏膜光滑,且基底内侧紧临右侧输尿管口外侧.在切除肿瘤前,在镍钛铬导丝引导下于右侧输尿管内逆行置入一根4.7Fr的输尿管支架管,防止损伤右侧输尿管口. 然后用钬激光完整剜除肿瘤,剜除深度达膀胱浅肌层. 后换用等离子电切设备切碎肿瘤后,冲洗出肿瘤组织送病理检查. 术后病理结果提示:膀胱平滑肌瘤( BL ).

目的 观察EphrinA2和EphA7在前列腺癌中的表达情况及其与临床病理特征、预后的相关性.方法 选取我院2010年5月—2012年12月收治的68例前列腺癌标本(观察组)及68例癌旁正常前列腺组织(对照组),检测EphrinA2和EphA7的表达情况,记录所有患者的性别、年龄、肿瘤及预后等情况.结果 观察组EphrinA2和EphA7表达水平显著高于对照组,差异有统计学意义(P<0.05).不同肿瘤分化程度、临床分期及是否出现骨转移和淋巴结转移的前列腺癌患者EphrinA2和EphA7的表达水平差异有统计学意义(P<0.05).EphrinA2表达阳性和非阳性的5年总生存率分别为27.03％(10/37)、45.16％(14/31),EphA7表达阳性和非阳性的5年总生存率分别为25.00％(8/32)、44.44％(16/36),差异均有统计学意义(P<0.05).多因素Cox比例风险回归模型分析显示,肿瘤分化程度、临床分期、出现骨转移和淋巴结转移及EphrinA2和EphA7表达阳性均为影响前列腺癌预后的独立危险因素(P<0.05).结论 肿瘤分化程度、临床分期、出现骨转移和淋巴结转移及EphrinA2和EphA7表达阳性均为影响前列腺癌预后的独立危险因素,且EphrinA2和EphA7表达情况可作为评估病情进展和预后的有效指标.

目的 探讨肾棘球蚴病的诊断、治疗及随访.方法 回顾性分析2013-01/2017-12四川省人民医院明确诊断为肾棘球蚴病的临床资料.结果 共确诊4例肾棘球蚴病,其中2例予以确定性手术治疗,1例探查后未予切除;1例放弃手术治疗.结论 早期发现彻底清除病灶并辅助药物治疗是治愈肾棘球蚴病的根本手段.

Forkhead box K1 (FOXK1) is a member of the FOX transcription factor family and plays an important role in the development of several tumors. However, the role of FOXK1 in the progression of prostate cancer remains unknown. Thus, the objectives of this study were to detect the expression of FOXK1 in prostate cancer and to examine its role in prostate cancer cells. We found that the expression of FOXK1 at both the mRNA and protein levels was significantly upregulated in human prostate cancer cell lines. In addition, the downregulation of FOXK1 obviously inhibited the cell proliferation of prostate cancer cells in vitro and attenuated tumor growth in a xenograft model in vivo. Furthermore, knockdown of FOXK1 suppressed the migration and invasion of prostate cancer cells, and prevented the EMT phenotype through upregulating the expression of E-cadherin, as well as downregulating the expression of N-cadherin in prostate cancer cells. Mechanistically, knockdown of FOXK1 efficiently downregulated the expression levels of β-catenin, c-myc, and cyclin D1 in PC-3 cells. Overall, our results demonstrated that knockdown of FOXK1 inhibited the proliferation and metastasis of prostate cancer, at least in part, through suppressing the Wnt/β-catenin signaling pathway. Therefore, these results suggest that FOXK1 may be a potential therapeutic target for human prostate cancer.

Objective:To study the safety and clinical efficacy of robot-assisted radical cystectomy and orthotopic ileal neo-bladder in patients with the urothelial carcinoma of bladder.Methods:The clinical data of 53 patients with bladder urothelial carcinoma undergoing robot-assisted radical cystectomy from November 2014 to April 2017 were analyzed and summarized on peri-operative and follow-up data including tumor pathology and function recovery.Results:The robotic-assisted radical cystectomy was successfully performed on 52 patients,and orthotopic ileal neo-bladder was done on 46 patients of them.There were no transfusion cases,and postoperative pathology surgical margin was negative.Three patients had concurrence of prostate cancer.The Foley catheter was removed one week after confirming no bladder-urethral anastomotic leakage and removing bilateral ureteral stents,and the average hospital stay was 22 d (12-33 d).The average daytime urinary continence was 27 d (1-71 d).Renal function was normal in all cases,and during the follow up period no hydronephrosis of upper urinary tract was found.Conclusions:Robot-assisted radical cystectomy and orthotopic ileal neo-bladder is feasible and safe upon the outcomes of preliminary surgery and short-term follow-up.The advantages of robotic surgical system render the smooth implementation of radical cystectomy,meanwhile preserving the neurovascular bundle and pelvic structure helps full recovery of urinary continence after surgery.To improve the long-term outcomes needs more experience and to comprehensively evaluate these techniques needs the controlled clinical trial.

Objective To study clinical effect of abdominal small incision combined with retroperitoneal laparoscopy in treatment of renal pelvic carcinoma,and possibly related factors influencing long-term prognosis.Methods A total of 78 patients with renal pelvic carcinoma treated during February 2009 and November 2010 were recruited in this study.The 30 patients with routine open radical nephro-ureterectomy were included in control group,while 48 patients with abdominal small incision combined with retroperitoneal laparoscopy were included in observation group.Operation results and incidence rate of postoperative complications were compared between the two groups.Conditions of tumor recurrence and metastasis and survival rate were observed during 5 years of follow-up.Possibly influencing factors of longterm prognosis were analyzed in observation group.Results Operations were successful in the two groups.Values of intraoperative blood loss volume,recovery time of postoperative intestinal function and length of stay in observation group were significantly lower than those in control group (P ＜ 0.05).Incidence rate of postoperative complications in observation group was significantly lower than that in control group (P ＜ 0.05).The 5-year survival rates of patients with tumor diameter equal or less than 2.5 cm,tumor cell grading G1-G2 and UICC pathological stage T1 and T2 were respectively higher than patients with tumor diameter more than 2.5 cm,tumor cell grading G3 and UICC pathological stage T3 and T4 (P ＜ 0.05,P ＜ 0.01).Conclusion Abdominal small incision combined with retroperitoneal laparoscopy has advantages such as less trauma,fewer incidence rate of complications and less blood loss.Tumor size,cell grading and pathological stage are the important factors influencing the long-term prognosis.