マイクロ波組織凝固装置を用いた腎部分切除術 体腔鏡下手術への応用

Abstract

マイクロ波組織凝固装置を用いた腎部分切除術について臨床的検討を行った.対象は, マイクロ波組織凝固装置で腎部分切除術を行った11例12腫瘍(男性10例, 女性1例・平均年齢61.0歳)で, 最近の4例では体腔鏡下で行った.手術時間は平均249分(開放252分, 体腔鏡下244分), 出血量は平均375ml(開放486ml, 体腔鏡下183ml), 全例輸血を要さなかった.術後合併症は腹膜炎1例(開放)で, 保存的治療で軽快した.術後腎機能では血中クレアチニンは開放, 体腔鏡下間で有意差はなく, クレアチニンクリアランスは開放で術後減少したが, 体腔鏡下では減少を認めなかった.腫瘍径は平均1.9cm, 病理組織所見は腎細胞癌9例(開放7例, 体腔鏡下2例), 出血性嚢胞3例(体腔鏡下), 全例でsurgical marginはnegativeであった.観察期間6年で全例に再発なく, 腎機能も良好である.以上, これらの成績からも, 出血量, 術後疼痛の軽減などから体腔鏡下手術は有用と考えられた

We report our clinical findings on 12 tumors (11 patients) successfully resected by partial nephrectomy with a microwave tissue coagulator (MTC) without renal pedicle clamping, including laparoscopic operation in 4 patients. All patients presented with a renal tumor detected incidentally by ultrasonography or computed tomography. The mean size of renal tumor was 1.9 (range 0.8-3.4) cm. Pathological diagnosis was renal cell carcinoma in 9 tumors and hemorrhagic cyst in 3 tumors. Mean operative time was 249 minutes. Mean blood loss was 183 ml in cases with a laparoscopic operation, that was statistically less than 486 ml in cases with an open operation (p<0.05), and 376 ml in all cases. There was no significant change in the creatinine clearance of cases with laparoscopic operation, compared with that of cases with an open operation. There were no other serious complications postoperatively. These findings suggested that partial nephrectomy with the MTC can be safely and successfully carried out while sparing renal function. Moreover, partial nephrectomy with the MTC for a laparoscopic operation may provide these patients with more benefits.