マイクロ波凝固術による後腹膜鏡下腎部分切除術の経験

Abstract

約3年間に鏡視下手術を行った13例と, ほぼ同時期に行った開放性手術11例との手術成績を比較した.開放性手術で男性が多い傾向にあり, 術前画像診断上の平均腫瘍径は開放性手術で有意に大きかった.鏡視下手術で輸血を要する出血をきたした症例が1例あり, 止血のため開腹手術へ移行した.開放性手術の手術関連合併症は尿瘻1例, 術後出血1例で, 輸血を要した症例は4例あったが3例は自己血だけで充足した.食事開始, 歩行開始は鏡視下症例で有意に早く, 術後入院期間も鏡視下症例で有意に短縮していた.鏡視下手術では開放性手術より有意に鎮痛剤の使用回数が少なかった.術前後に99mTc-DDTPAによる腎シンチグラフィーを行った鏡視下症例3例と開放性症例5例について検討したところ, 患側のGFRは開放性症例で鏡視下症例より低下する傾向を認めた

Partial nephrectomy is widely accepted as a treatment for small renal cell carcinoma. However, the laparoscopic approach has not yet been considered as a standard procedure. We reviewed our 13 retroperitoneoscopic partial nephrectomies and 11 conventional open partial nephrectomies. We have used microwave tissue coagulation for retroperitoneoscopic surgery without renal pedicle clamping between December 1999 and May 2003. The mean operating time for the retroperitoneoscopic group was not significantly longer than that for conventional open surgery group (183 minutes vs 194 minutes). However, the mean blood loss for the retroperitoneoscopic group was less than that for the open group (143 ml vs 512 ml). Histologic evaluation revealed renal cell carcinoma in 10 patients, angiomyolipoma in 2 patients, and lymphoangiomyomatosis in one patient for retroperitoneoscopic group and renal cell carcinoma in 11 patients for the conventional open surgery group. In addition, when compared with the historical control that had undergone conventional partial nephrectomy, laparoscopic cases had significantly shorter postoperative times to oral intake, ambulance, and discharge from hospital. Bowel injury, massive bleeding, urine leakage, and atelectasis occurred in one case each in retroperitoneoscopic surgery. Retroperitoneoscopic surgery in the case of massive bleeding was converted to open surgery. On the other hand, urine leakage and postoperative hemorrhage occurred in one case each in conventional open surgery. Retroperitoneoscopic partial nephrectomy by using microwave tissue coagulation is a useful and less invasive method, whereas this procedure is more challenging than open partial nephrectomy in terms of complications.