鏡視下腎摘除術の臨床的検討:一地方大学病院における施設としてのラーニングカーブ  [in Japanese] Laparoscopic nephrectomy ; Learning curve of a university hospital  [in Japanese]

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Abstract

  2002年1月~2012年12月までに福井大学において鏡視下腎摘除術を施行した腎腫瘍121例の臨床成績をまとめた.手術施行の時期別に鏡視下腎摘除術導入直後のⅠ期16例,ハンドアシスト法を基本術式として施行したⅡ期33例,執刀医を2名に固定し基本術式をpure laparoscopy法に再変更したⅢ期18例,2名が技術認定医を取得し指導医として手術参加したⅣ期54例に分類して検討した.それぞれの時期の腫瘍径の平均値,手術時間,出血量の中央値,開腹移行率は5.0 / 4.3 / 3.2 / 3.7 cm,224 / 216 / 186 / 202分,140 / 100 / 28 / 20 ml,12.5 / 0 / 5.5 / 7.4%であった.病理結果が腎細胞癌であった113例のうち,手術時に遠隔転移のなかった103例の5年非再発率と疾患特異的生存率は,それぞれ89.4%,96.7%であった.当科においては,手術時間の有意な短縮は見られなかったものの,出血量は経験とともに減少した

  We retrospectively analyzed the clinical results for 121 patients with renal tumor who underwent laparoscopic nephrectomy at the University of Fukui between January 2002 and December 2012. Patients were retrospectively divided chronologically into 4 eras, as follows : era 1 : initial 16 cases ; era 2 : 33 cases, hand-assisted nephrectomy was mainly performed ; era 3 : 18 patients, procedure was performed by one of 2 fixed surgeons ; and era 4 : 54 patients, procedure was performed by surgeons under the direction of surgeons certified by the Endoscopic Surgical Skill Qualification System in urological laparoscopy. For these eras, the mean tumor sizes were 5.0, 4.3, 3.2, 3.7 cm, the median operating times were 224, 216, 186, and 202 min, the estimated blood losses were 140, 100, 28 and 20 ml, and the conversions to an open procedure were 12.5%, 0%, 5.5%, 7.4%, respectively. In the 103 renal cancer patients without metastasis, the 5-year recurrence-free survival rate and cause-specific survival rate were 89.4% and 96.7%, respectively.

Journal

  • Japanese Journal of Endourology

    Japanese Journal of Endourology 26(2), 246-251, 2013

    Japanese Society of Endourology

Codes

  • NII Article ID (NAID)
    130004627222
  • Text Lang
    JPN
  • ISSN
    2186-1889
  • Data Source
    J-STAGE 
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