マイクロ波凝固装置を用いた腎部分切除術の臨床的検討―腹腔鏡下手術と開放手術の比較について―

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We compared efficacy, morbidity, and convalescence between laparoscopic and open nephron sparing surgery using a microwave tissue coagulator without renal pedicle clamping. Laparoscopic and open nephron sparing surgeries were performed for 11 and 5 patients, respectively, with small renal cell carcinoma from 1991 to 2002. Comparable results of laparoscopic nephron sparing surgery were obtained to open surgery regarding operation time, blood loss and postoperative renal function. However, two patients were converted to open surgery due to residual malignant cells, and each of them underwent subsequently open radical or partial nephrectomy. Another patient required open nephrectomy after laparoscopic nephron-sparing surgery due to the prolonged urine leakage and uncontrolled infection. Infundibular stenosis and calyectasis developed in a patient 3 months after open surgery. A microwave tissue coagulator was useful to control parenchymal bleeding without real pedicle clamping during laparoscopic and open nephron-sparing surgery. However, to prevent post-operative complications such as urine leakage and infundibular stenosis, it should be contraindicated in a case of renal cell carcinoma buried in parenchyma or near the calyx, sinus and large renal vessels.
特定非営利活動法人 Microwave Surgery研究会の論文