水腎症を伴う傍腎盂嚢胞に対する体腔鏡下嚢胞壁切除術

Abstract

水腎症を伴う傍腎盂嚢胞に対する体腔鏡下嚢胞壁切除術を経験した.対象は, 腎門部近傍に存在し傍腎盂嚢胞に起因する水腎症を呈した6例(男性4例, 女性2例・平均年齢58.6歳)で, 水腎症の程度はgrade 1が2例, grade 3が3例, grade 4が1例であった.経過観察期間は平均29.6ヵ月で, 手術時間は平均143分, 出血量は平均21cc, 術後入院日数は平均4.1日で, 食事開始は平均術後1.2日, 歩行開始は全例術後1日目であった.術後鎮痛剤使用は2例あり, いずれも1～2回であった.合併症や輸血を要した症例は認めなかった.病理組織検査では全例が単純嚢胞で, 嚢胞内に悪性腫瘍を疑う所見は認めなかった.術後1ヵ月目の経静脈的腎盂造影(IVP)では, 全例に水腎症の改善を認め, 現在まで再発は認められていない

Laparoscopic unroofing of renal cyst has replaced open surgical intervention in recent years. We report our experience with this procedure on 6 patients with hydronephrosis due to peripelvic cyst. Four male and two female patients, ranging from 51 to 67 years, underwent laparoscopic unroofing of peripelvic cyst. All patients had various degrees of hydronephrosis. Two patients had lumbago and hematuria. The cause of this hematuria was probably due to the renal pelvic stone. Surgical approaches i.e., retro- or transperitoneal were selected depending on the location of cyst. The operative time ranged from 80 to 235 minutes (mean 167 minutes). The length of postoperative hospital stay ranged from 3 to 7 days (mean 4.6 days). Intraoperative blood loss ranged from 20 to 26 cc (mean 21 cc). Four weeks after the operation, all patients showed improvement of hydronephrosis. Laparoscopic unroofing of peripelvic cyst is a safe and efficacious procedure, and could be an attractive alternative for management of peripelvic renal cysts.