T2以下の腎癌における鏡視下手術と開放手術の比較

Abstract

T2以下の腎癌における鏡視下手術と開放手術の比較検討を行った.対象は, 根治的腎摘除術を受けたTNM分類T1, T2の腎癌症例84例で, 内訳は鏡視下手術53例(T1 47例, T2 6例), 開放手術31例(T1 24例, T2 7例)であった.両群における性別, 患側, 病期, 平均年齢, 平均腫瘍径, 平均手術時間で有意差は認めなかったが, 平均術中出血量は鏡視下手術123ml, 開放手術469ml, 平均術後歩行開始日はそれぞれ1.2日, 3.1日, 平均術後食事開始日は1.4日, 4.6日, 平均術後在院日数12.8日, 40.0日と有意差を認めた.合併症は, 鏡視下手術の群では透析患者の1例で術後1日目に後腹膜血腫を認め血腫除去術を行い, 開腹手術の群では出血で輸血を3例に施行し, 術後肺炎1例, 術後イレウス1例を認めた

The aim of this study was to compare the efficacy, efficiency and patient well-being of endoscopic radical nephrectomy (ERN) with those of open radical nephrectomy (ORN) in patients with stage T1 and stage T2 renal cell carcinoma during the period from 1995 to 2003. Eighty-four patients including 53 patients receiving ERN and 31 patients receiving ORN were evaluated. The two groups were analyzed for sex, side of tumor, clinical stage, age, tumor diameter, operative time, operative blood loss, postoperative time to oral intake and ambulation. There was no difference in patient background between the ERN and ORN groups. Although the mean operative times between the ORN and ERN group were not different (mean 240 versus 267 min. in ERN group, P=N.S.), ERN patients had significantly less operative blood loss (mean 123 versus 469 ml. in ERN group, P < 0.01), significantly shorter time to start the oral intake of rice gruel (mean 1.4 versus 4.6 days. in ERN group, P < 0.01) and significantly shorter time to ambulation (mean 1.2 versus 3.1 days. in ERN group, P < 0.01). These findings revealed that endoscopic radical nephrectomy for the patients with stage T1 and T2 renal cell carcinoma appears to be associated with less morbidity and faster recovery rather than open radical nephrectomy.