精巣腫瘍に対する腹腔鏡下後腹膜リンパ節郭清術の臨床的検討

Abstract

右精巣腫瘍ステージI nonseminomatous germ cell tumor(NSGCT)3例, 化学療法後の右精巣腫瘍ステージIII NSGCT 2例, 左精巣腫瘍ステージIII seminoma1例に対する腹腔鏡下後腹膜リンパ節郭清術の成績を報告した.手術時間は3.0～5.3時間(平均3.9時間), 出血量は50～247ml(平均114ml)であった.1例では腰静脈を下大静脈流入部で損傷したが, 損傷部にクリップをかけることによりコントロールできた.6例とも術後1日目より経口摂取と歩行を開始し, 勃起障害, 射精障害はなく, 術後3～27ヵ月の現在, 再発は認めていない

Three patients with stage I disease and 3 patients with stage III disease were treated with laparoscopic retroperitoneal lymphnode dissection. The patient was placed in a semilateral position and 5 trocars were introduced through the lateral abdominal wall. After incising the peritoneum along the Toldt line, the colon was reflected medially and the retroperitoneal structures such as the ureter, aorta, inferior vena cava and both renal arteries and veins were exposed. For right-side disease the paracaval and interaortocaval lymphnodes were dissected, and for left-side disease, the interaortocaval and paraaortic lymphnodes were dissected. The procedure was completed successfully on all 6 patients. The average operative time was 3.4 hours for 3 patients with stage I disease and 4.4 hours for 3 patients with stage III disease treated with prior chemotherapy. All patients started to walk and resumed oral intake from the first post-operative day and the average duration to full convalescence was 21 days. Anteriograde ejaculation and erection were preserved in all six patients. Laparoscopic retroperitoneal lymphnode dissection will be a useful technique for management of testicular cancer.