腹腔鏡下腎部分切除術

Abstract

著者らは1999～2004年の間に, 術前診断で腎癌を疑い, 腹腔鏡下腎部分切除術を24例に施行した.その手術方法について解説した.1)腫瘤径が小さく, 腫瘤と腎杯, 腎洞との距離が1cm以上ある場合は, 超音波メス等の道具を用いて腎動静脈の血流遮断を行わずに腫瘤を切除し, 12例中10例で成功した.2)腫瘤と腎杯, 腎洞との距離が1cm未満で腎杯を切開する可能性が高い症例に対しては, 腎血流を遮断した後に腫瘤を切離し, 必要に応じて腎杯縫合, 腎実質縫合を行った.3)血流遮断を行った症例での平均阻血時間は26分で, imperative caseでも術後の腎機能の低下は軽度であった.4)病理診断が腎癌であった症例の予後は, elective case 11例では再発はみられず, imperative case 6例のうち2例で局所再発を認めた

We retrospectively reviewed the clinical results of 24 patients who underwent laparoscopic partial nephrectomy by a diagnosis of renal cell carcinoma (RCC) between 1999 and 2004, including 16 elective cases and 8 imperative cases. Twenty-two were successfully treated laparoscopically; two cases in the imperative group required conversion to open surgery because of uncontrollable bleeding. A vascular clamp was used in 12 cases for an average of 26 minutes. The creatinine clearance changed from 98 to 93 ml/min in the elective cases and from 49 to 44 ml/min in the imperative cases. Pathological evaluation revealed RCC in 10 elective cases and 6 imperative cases. Local recurrence (renal hilum lymph node and ipsilateral kidney) was found in 2 patients in the imperative group. Although laparoscopic partial nephrectomy is useful, long-term follow-up is necessary for evaluating the tumor control.