70°斜卧位腹腔镜治疗上尿路移行细胞癌

70° recumbent position transperitoneal laparoscopy for treatment of upper urinary tract transitional cell carcinoma

目的探讨70°斜卧位经腹入路腹腔镜治疗上尿路移行细胞癌的临床效果。方法2004年5月至2007年1月联合尿道电切镜、70°斜卧位经腹入路腹腔镜肾输尿管切除治疗上尿路移行细胞癌（TCC）31例，同时采用钛夹夹闭输尿管或输尿管肿瘤两端，下腹斜形切口取出标本。结果31例手术均成功，无术中转开放；平均手术时间140min，平均出血量80ml，平均住院时间8d，无尿漏、肠瘘等并发症发生。结论70°斜卧位经腹入路腹腔镜肾输尿管全长切除术具有手术操作空间大、肾蒂血管处理简单、手术风险小、创伤轻、术后恢复快等优点，值得临床推广应用；但其对肿瘤播散、复发等的影响还需要长期的观察随访。

Objective To study the effect of 70° recumbent position transperitoneal laparoscopy for treatment of upper urinary tract transitional cell carcinoma （TCC）. Methods From May 2004 to January 2007, 70° recumbent position transperitoneal laparoscopy combined with urethral resectoscope was used to treat 31 cases of upper urinary tract transitional cell carcinoma. At the same time titanium clip to occlude the two extremities of ureter tumor was used, extracting specimen by oblique incision of lower quadrant. Results All operations were finished successfully, no one was turned to open surgery; mean operation time was 140 min, mean blood loss 80 ml, mean hospital stay time 8 d, without complications of urine leakage and intestinal fistula and so on. Conclusions 70° recumbent position transperitoneal laparoscopy for resection of whole kidney and ureter is worth of general clinical application because it could provide large space for operation, simplify the treatment of renal pedicle vessels, decrease operation risk, reduce operation trauma and offer early recovery. But its effect on tumor spread and recurrence will still need long term follow-up.