マイクロ波組織凝固装置を用いた腎部分切除術 - 術後再発と残腎機能 -

Abstract

著者らは直径7cm以下の腎細胞癌症例121例(124腎)に対して, 主に開腹術でマイクロ波組織凝固装置を用いた腎部分切除を施行してきた.その手術成績を評価し, 術後再発等の予後と, 術後の残腎機能を中心に報告した.輸血を要したのは8腎で, 1例は腎摘除術を余儀なくされた.術中に腎盂腎杯の開放を20例に認め, 修復を行ったが, 5例は術後も尿漏を認め, 1例は改善しなかった.術後1ヵ月以内に多発性腎細胞癌, 浸潤型紡錘細胞癌, 前述の長期尿漏遷延の3例に腎摘除術を施行した.他に患側腎での再発のため術後2年目に1例に摘除術を施行した.腎機能は, クレアチニン値, クレアチニンクリアランスの推移からみて良好に温存されていた.単腎症例1例で術後6ヵ月, 嚢胞腎症例1例で術後11年目に腎機能が悪化し, 透析が導入された.局所再発を認めたのは1例, 癌なし生存は107例で, 腎機能に問題のなかった99例は全例癌なし生存であった

Nowadays, partial nephrectomy is often selected for treatment of small renal cell carcinoma (RCC) because T1a RCC shows a favorable prognosis with a 5-year overall-survival rate exceeding 90%. To determine the methodological usefulness and treatment outcome of partial nephrectomy using microwave tissue coagulator (MTC), we evaluated our series of 121 patients (124 kidneys) with T1 RCC who underwent this procedure. Ninety-nine patients were elective and 22 patients were imperative cases. This procedure was indicated for asymptomatic solitary RCC; < or =4 cm in diameter in elective cases or < or =5 cm in imperative cases, expanding outward with a clear capsule, and showing neither renal pelvis nor renal sinus invasion. The median operation time was 150 minutes and the median blood loss was 217 ml. Eight patients needed transfusion, and conservative therapy cured 4 patients of postoperative urine leakage successfully. Three patients underwent early secondary nephrectomy due to multiple RCCs, invasive spindle cell carcinoma, or prolongation of urine leakage. No significant deterioration of renal function by creatinine clearance (Ccr) was observed, and postoperative Ccr could be precisely predicted from preoperative serum creatinine value and the renal parenchymal volume estimated with 3-dimensinal image reconstruction. Five-year overall-survival rate was 91% at the mean follow-up of up to 37.9 months and 107 patients were alive without disease. One patient showed local recurrence 2 years later and underwent radical nephrectomy. We believe that non-ischemic partial nephrectmy using MTC is a simple and reliable nephron-sparing surgery for small RCC in respect of postoperative recurrence and preservation of renal function.