腹腔鏡下腎摘除術の経験

Abstract

36歳男, 腎盂尿管移行部狭窄による左無機能腎に対し, 腹腔鏡下腎摘出術を行った.CO2気腹下に5本の外套管を刺入して腎を剥離し, 腹腔内に挿入した袋を用いて遊離した腎を細切し, 穿刺創を延長することなく体外に摘出した.手術時間は585分であった.術後に約310 mlの後出血あるも自然に止血, 術後3日目に歩行, 9日目に退院した

Laparoscopic procedures are promising techniques which allow less invasive surgery not only for intra-abdominal organs but also for retroperitoneal organs. Laparoscopic nephrectomy was first described by Clayman et al. We removed the left kidney of a 36-year-old male patient using laparoscopic procedures according to Clayman's technique. The kidney had developed hydronephrosis due to congenital ureteropelvic junction stenosis. In the peritoneal cavity the freed kidney was pushed into a Lapsac, minced using scissors and forceps, and removed without elongation of the wound. During the operation, pneumoperitoneum with CO2 gas induced increases in PaCO2, central venous pressure, pulmonary artery wedge pressure and cardiac output, all of which the patient tolerated well. The patient was discharged from the hospital on the 9th postoperative day. Laparoscopic nephrectomy is a useful alternative to the conventional open surgery in selected cases, when surgical techniques and instruments are improved appropriately.