マス・スクリーニング発見腹部神経芽腫群腫瘍に対する腹腔鏡下腫瘍摘出術の経験 : 開腹手術との比較検討  [in Japanese] Laparoscopic Resection of Retroperitoneal Neuroblastoma Detected by a Mass Screening Test as an Alternative to Open Laparotomy  [in Japanese]

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Abstract

【目的】マス・スクリーニング(MS)で発見された副腎原発,または後腹膜原発(以下,腹部)神経芽腫群腫瘍5症例に対して腹腔鏡下腫瘍摘出術を行った.これら5例について検討を加え,後腹膜腔腫瘍における腹腔鏡手術の有用性を評価した.【対象と方法】対象はMSで発見された7〜9か月の男児4例,女児1例で,原発巣は右後腹膜腔2例,左後腹膜腔3例であった.全例無症状で,国際病期分類stage 1であった.対照群として,腹腔鏡手術導入以前の開腹手術MS症例6例を選び,手術時間,出血量,術後経口摂取開始期間,在院日数,合併症について比較検討した.【結果】腫瘍が腎動静脈間に入り込んでいた1例を除けば,前半の2例に比べて後半の2例では手術時間の短縮がみられた.術中に腎上極の血行障害が1例にみられた他には合併症は無かった.開腹手術症例と比較すると手術時間は有意に長かったが,出血量は有意に少なかった.術後の経口開始期間や入院期間・炎症所見では有意な差はみられなかった.【考察】今回の調査では客観的に腹腔鏡手術の方が低侵襲であるというデータは得られなかったが,他の疾患により腹腔鏡操作に慣れていくことで本術式は腫瘍径の小さい後腹膜腔腫瘍の有用な治療法となることが期待される.

Purpose: Laparoscopic surgery is a minimally invasive procedure even in infants. We reviewed our experiences of laparoscopic resection in retroperitoneal neuroblastoma detected by a mass screening test (NBMS). Materials and Methods: Five patients with retroperitoneal NBMS underwent laparoscopic resection (LR group). Their ages ranged from 7 to 9 months; four were male and one female. Three tumors were found in the left retroperitoneum and two in the right. There were no symptoms, and all were in INSS 1. We compared surgery time, amount of blood loss, post operative fast period, length of hospital stay (LHS), and complications between the LR group and the 6 cases which underwent open laparotomic resection (OR group). Results: In the LR group, the surgery time of the two most recent cases was shorter than that of the first two cases. There were no complications other than a temporary circulatory disturbance to the upper pole of the kidney. Although operation time in the laparoscopic group was significantly longer than in the open group, the amount of blood loss was significantly smaller. There were no significant differences in the postoperative fast period or LHS. Conclusions: Due to the small number of cases, it is difficult to conclude the usefulness of laparoscopic resection in retroperitoneal tumors. However, laparoscopic resection has the potential to be an effective treatment for retroperitoneal tumors in infants.

Journal

  • Journal of the Japanese Society of Pediatric Surgeons

    Journal of the Japanese Society of Pediatric Surgeons 43(7), 913-918, 2007

    The Japanese Society of Pediatric Surgeons

References:  16

Codes

  • NII Article ID (NAID)
    110006570174
  • NII NACSIS-CAT ID (NCID)
    AN00192281
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    0288-609X
  • NDL Article ID
    9320816
  • NDL Source Classification
    ZS35(科学技術--医学--外科学・整形外科学・麻酔学)
  • NDL Call No.
    Z19-244
  • Data Source
    CJP  NDL  NII-ELS  J-STAGE 
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