腎細胞癌におけるリンパ節郭清

Abstract

腎細胞癌56例を対象に, リンパ節郭清の術式, 手術成績, 問題点について検討した.後腹膜腔への到達経路は, 22例が経胸腹的到達法, 34例が経腹的到達法を用いたが, いずれの場合もまず根治的腎摘除術をおこない, ついでリンパ節郭清を施行している.郭清の範囲は所属リンパ節, すなわち左右の腎茎部リンパ節, 旁下大静脈リンパ節, 大動脈間リンパ節, 旁大動脈リンパ節のすべてを郭清するのを原則としている.リンパ節郭清に要した手術時間は平均1時間40分, 平均出血量は350 mlであった.リンパ節郭清による術中合併症としては, 血管損傷が3例にみられたが, とくに左第2腰静脈の損傷に注意しなければならない.術後合併症は出血, 乳糜腹水が各1例みられた.リンパ節郭清にさいしては, リンパ管の結紮を細心におこなうことが大切である.リンパ節転移のみられた6例の5年生存率は33%で, リンパ節郭清が予後の改善に寄与していたと推測される

The techniques, results and problems of lymphadenectomy were assessed in 56 cases of renal cell carcinoma. As the approach to the retroperitoneum, the thoracoabdominal approach was used in 22 cases and transabdominal approach in 34 cases. Radical nephrectomy was performed, followed by lymphadenectomy. All of the regional lymph nodes were dissected. The mean time required for lymphadenectomy was 1 hour and 40 minutes and the mean volume of blood loss was 350 ml. As intraoperative complications, vascular injury occurred in 3 cases. In 1 of these cases the left second lumbar vein was injured. Therefore, in lymphadenectomy caution should be exercised not to give injury to this blood vessel. The postoperative complication observed included bleeding and chylous ascites in 1 case each. In performing operations one must ligate the lymphatic vessel carefully. The 5-year-survival rate for 6 cases associated with metastasis to lymph node was 33%. From this fact, it was postulated that lymphadenectomy is helpful to improve prognosis of these patients.