前立腺癌に対する腹膜外アプローチによる腹腔鏡下骨盤内リンパ節切除術

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腹膜外アプローチによる腹腔鏡下骨盤内リンパ節切除術は,少ないトロッカー及び人数で操作可能であり,閉鎖腔の視野も良く,炭酸ガス送気(送気圧5mmHg)の影響もなく,手術侵襲等について更に検討を要する点もあるが,腹腔からのアプローチに代わりうる方法と考えられたBetween February 1994 and February 1995, we performed retroperitoneal laparoscopic pelvic lymphadenectomy on 7 patients with prostate cancer between 63 and 76 years old, consisting of 6 patients with clinical stage B2, and 1 patient with stage C. Retroperitoneal laparoscopic procedures were performed under general anesthesia. First, the prevesical space was separated by a balloon dissector to create the working space. Then, three trocars were inserted into the retroperitoneal space at the lower abdominal midline. Except for the first patient, only two surgeons were needed to dissect the obturator lymph nodes, under 5 mmHg CO2 insufflation. The mean operating time was 133 minutes for bilateral lymphadenectomy. The mean number of removed lymph nodes was 4.8 on the left side and 4.2 on the right side. The estimated blood loss ranged from 10 to 66 ml. As none of the patients showed node involvement on the microscopic examination of the frozen section, they immediately underwent total prostatectomy. Additionally removed lymph nodes were 0.8 on the left side and 1.5 on the right side. As for intraoperative complications, endotidal CO2 was elevated in the first patient, but the other patients had no complications. Retroperitoneal laparoscopic pelvic lymphadenectomy is a safe and useful procedure, and may facilitate a lymphadenectomy better than a peritoneal procedure.

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青木雅信
藤枝市立総合病院泌尿器科

前立腺癌に対する腹膜外アプローチによる腹腔鏡下骨盤内リンパ節切除術

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