神戸市立中央市民病院における腎癌に対する鏡視下根治的腎摘除術の検討

Abstract

腎癌21例を対象に鏡視下根治的腎摘除術を行い, その成績, 合併症, 腎へのアプローチの差について検討した.腎へのアプローチは基本的に後腹膜到達法とし, cT2, 腎上極5cm以上のもの, 腎茎背側に突出するものは経腹膜到達法とした.その結果, 1)後腹膜到達法は12例, 経腹膜到達法は9例で施行した.2)経腹膜到達法と比べ後腹膜到達法は腎動脈遮断から腎静脈切断までの時間が有意に短く, 平均出血量も少なかった.3)手術時間と出血量, 腫瘍径と鎮痛剤の使用量, BMIと手術時間には相関を認めた.4)術中合併症は, 軽度の無気肺を1例で認めたが, 開腹移行例はみられなかった.5)術後平均観察期間14.9ヵ月で, 1例に再発を認めたが, 全例生存中である

Between April 2002 and March 2004, 21 patients with clinical T1-T3a renal cell carcinoma underwent laparoscopic radical nephrectomy at the Kobe City General Hospital. A transperitoneal approach was chosen in 9 patients with clinical T2 stage, tumors more than 5 cm in diameter at the upper pole of the kidney, and posteriorly protruded tumors at the middle portion. Otherwise, a retroperitoneal approach was chosen in 12 patients. The mean (range) operative time for the transperitonal and retroperitoneal approaches was 355 (290-410) min and 342 (275-490) min, respectively. There were no major intraoperative complications. Postoperatively, one patient underwent emergency operation due to the perforation of duodenal ulcer. In the mean follow-up of 15.9 months, lung metastasis was seen in one patient under adjuvant immunotherapy. Significant differences between transperitoneal and retroperitoneal approaches were seen in mean time to renal artery clipping (170 versus 85 min, p < 0.01), mean blood loss (548 versus 281 ml, p < 0.05) and concurrent adrenalectomy (66.7 versus 16.7%, p < 0.05). Laparoscopic radical nephrectomy is a safe and feasible procedure when suitable approaches are chosen depending on tumor size and location.