後腹膜鏡下ハンドアシスト法および開放腎尿管全摘除術の比較検討
| Autor: | Sato, Yoshikazu, Nanbu, Akihito, Tanda, Hitoshi, Kato, Shuji, Onishi, Shigeki, Nakajima, Hisao, Nitta, Toshikazu, Koroku, Mikio, Akagashi, Keigo, Hanzawa, Tatsuo |
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| Jazyk: | angličtina |
| Rok vydání: | 2006 |
| Předmět: | |
| Zdroj: | 泌尿器科紀要. 52(12):903-909 |
| ISSN: | 0018-1994 |
| Popis: | The goal of this study is to compare surgical and oncological outcomes of laparoscopic nephroureterectomy and the open surgery using the concept of systemic inflammatory response syndrome (SIRS) in addition to common variables. Thirty-six and 23 patients having upper urinary tract urothelial cancer who were operated on with retroperitoneoscopic hand-assisted nephroureterectomy (RHANU) or standard open nephroureterectomy (ONU) retrospectively, were analyzed. Median operation time was 140 (range 70-200) and 60 (range 45-85) minutes, respectively in the RHANU group and the ONU group. The median days to ambulation and hospital stay of the RHANU group were significantly shorter than those of the ONU group. There was no significant difference in the incidence of SIRS and other surgical results between the two groups. In oncological outcome, no significant difference was found in the bladder recurrence rate (RHANU vs. ONU; 52% vs. 45%), local recurrence (0% vs. 0%), distant metastasis (11% vs. 13%) or survival rate (94% vs. 91%) between the RHANU group and the ONU group at 2-year follow-up. There was no port site recurrence in the RHANU group. Although the RHANU may have an advantage in terms of earlier recovery, there were no significant differences in the incidence of SIRS and oncological outcomes between the RHANU group and the ONU group. 腎盂尿管腫瘍に対する体腔鏡下および開放腎尿管全摘除術につき手術成績、術後経過を比較検討する。全身的侵襲性の指標としてsystemic inflammatory response syndrome(SIRS)の発症頻度に関しても比較検討を行う。腎盂尿管腫瘍に対して腎尿管全摘除術を施行した体腔鏡下手術36例(2002年4月～2004年12月)開放手術(ONU)23例(1999年1月～2001年12月)を対象とした。体腔鏡下手術は後腹膜鏡下ハンドアシスト法(RHANU)を用いた。手術時間(中央値)はRHANU群140分、ONU群60分とONU群で有意に短かった。出血量は両群とも平均約150mlであった。RHANU群において歩行開始日が有意に短縮していた。SIRSの頻度はRHANU群17%、ONU群26%と有意差を認めなかった。膀胱再発率は52, 45%(以下RHANU群vsONU群)、遠隔転移11, 13%、局所再発は両群とも認めず2年での生存率は94, 91%であった。体腔鏡下手術では、歩行開始日が有意に短く早期の回復が示唆された。SIRSの頻度、再発・転移・生存率に有意な差を認めなかった。体腔鏡下手術のリスク、術式の患者への利点を充分考慮した手術方法の選択が重要と思われた。(著者抄録) |
| Databáze: | OpenAIRE |
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