腎癌に対する鏡視下根治的腎摘除術 : standard法とhand-assist法の比較

A laparoscopic radical nephrectomy(LRN)for renal cancer can be performed using two methods,hand-assisted laparoscopic surgery(HALS)and standard laparoscopic surgery(SLS). This institute initially used HALS to perform all radical nephrectomy,but gradually shifted to SLS. This study compared the two methods of radical nephrectomy: HALS vs. SLS, which were performed at a single institute. From March 1999 to November 2006, a total 129 patients with pathologically confirmed renal cell carcinoma underwent LRN, including 73 patients with the HALS and 56 patients with SLS. The median operative time was 264 minutes,and median estimated blood loss was 200ml in the HALS group,respectively. The median operative time and median estimated blood loss in the SLS were 215 minutes and 100 ml,respectively. There was no significant difference in either the operative time or estimated blood loss between HALS and SLS. The median time to both postoperative oral intake and ambulation in the SLS were 1 day. Neither of these events after SLS was significantly shorter than that after HALS. The 4-year disease-free and overall survival rates in the HALS patients were 97.5% and 98.2%, respectively. Both the 4-year disease-free and overall survival rates in the SLS patients were 100%. Since no significant differences were observed between the two operative methods (SLS and HALS) regarding the operative data, postoperative course and oncological outcome,the surgical method for LRN can be selected according to characteristics of each surgical method【目的】腎癌に対する鏡視下根治的腎摘除術には，ハンドアシスト（hand-assisted laparoscopic surgery：HALS）法とスタンダード（standard laparoscopic surgery：SLS）法がある．鏡視下 根治的腎摘除術におけるHALS 法とSLS 法について比較した．【方法】99 年３月から06年11月 までに計129 例（HALS：73例，SLS：53例）の鏡視下根治的腎摘除術を行った．手術成績・術後 経過・合併症・非再発率・生存率について比較検討した．【結果】HALS とSLS の手術時間/出血量 は，それぞれ264・215分，および200・100mlであった．経口摂取・歩行開始までの期間および術 後入院期間について差はなかった．HALS における４年非再発率は97.5％，４年生存率は98.2％で あり，SLS の４年非再発率・生存率はともに100％であった．【結語】手術時間・出血量・術後経過 について，HALS とSLS で有意差はなく，それぞれの手術の特徴を考慮し術式を選択すべきと思わ れた