前立腺癌に対する除睾術に関する一考案 : 経鞘膜的除睾術について

Abstract

Subcapsular orchiectomy is the most commonly p erformed procedure in the endocrine treatment of prostatic carcinoma. However, it has been described by McDonald et al. and O'Conor et al. that there are significant numbers of Leydig- like cells remaining in the tunica albuginea and neighboring area of testis after subcapsular orchiectomy. Therefore, the orchiectomy including tunica albuginea and epididymis is considered to require in eradicating androgen-secreting tissue in the scrotum. A technique of transvaginal orchiectomy w as presented here, which was considered more radical than subcapsular orchiectomy and more beneficial in cosmetic reason than total orchiectomy. Te chnique : A transverse incision is made on the anterior scrotal skin under local or spinal anethesia. The incision is carried through the skin, cremasteric fascia, cremaster and tunica vaginalis testis preserving the tunica albuginea (Fig. 1). After the incision entering the vaginal space, the vas deferens is clamped, ligated and severed transvaginally at the level of upper pole of the testis, then vascular element is similarly isolated (Fig. 2, 3 and 4). The gubernaculum and remaining mesorchium are cross clamped and transected to complete the removal of the organs (Fig. 5). The incision is then approximeted and closed with skin sutures.