腎腫瘍に対する経腹式腎摘出術 - 腎茎血管の処理について -

Abstract

At surgery for renal carcinoma, it is required to ligate the renal artery and vein as early as possible besides complete removal of neoplastic tissue including lymph nodes. In this paper, the method of our radical nephrectomy is described with emphasis on the handling of the renal pedicle vessels. Regardless of the affected side, the retroperitoneum is opened at the right margin of the descending portion of the duodenum. The renal pedicle is reached with Kocher's maneuver. In case of renal carcinoma of the right side, the space between aorta and inferior vena cava is entered and then the renal artery is reached at the left side of vena cava and ligated followed by ligation of the right renal vein. In left renal carcinoma, the duodenum and head of the pancreas are well retracted towards the left side according to Kocher's maneuver. The left renal artery is first ligated and divided followed by the left renal vein. The retroperitoneum is again opened lateral to the descending colon and the kidney is removed. The renal pedicle vessels are able to be ligated with the least manipulation of the kidney itself if above method is done. At the ligation of the pedicle vessels, it is very important to ligate the renal artery first. According to our experimental study using the dog, ligation of the renal vein before that of the artery gives rise to an increase of blood flow into the collateral venous circulation, a sudden increase of the thoracic duct lymphatic flow and thus high risk of spread of cancer cells into the blood or lymphatic channels. As mentioned above, the renal pedicle vessels must be reached under the least manipulation of the tumor-bearing kidney and the renal artery must be ligated first. This might result in the improvement of the therapeutic result of renal cancer by minimizing the risk of intraoperative spread of cancer cells into the blood and lymphatic circulation.