―囊胞性腎疾患―多発性囊胞腎・単純性腎囊胞に対する内視鏡下手術

Endoscopic surgery for renal cystic disease : polycystic kidney disease and simple renal cyst

　要旨：囊胞性腎疾患の手術としては，腎囊胞開窓術，腎摘除術，経皮的腎動脈塞栓術，経皮的腎囊胞穿刺術，経皮的腎囊胞固定術などがある．いずれの手術も頻度が低いものであるが，本稿では多発性囊胞腎および単純性腎囊胞に対する内視鏡下手術について述べる．

　多発性囊胞腎に対しては，腹部膨満・疼痛・感染などの症状が強い場合に，内視鏡下腎囊胞開窓術が選択される．囊胞開窓術の術式は比較的容易であるが，目的と合併症を十分に説明して行う必要がある．腎機能が終末期の場合に腎摘除を行う適応があれば，内視鏡下腎摘除術もしくは経皮的腎動脈塞栓術を行う．単純性腎囊胞で有症状の場合には内視鏡下腎囊胞開窓術が選択されることがある．

　Surgical procedures for renal cystic disease include decortication of renal cyst, nephrectomy, transcatheter renal arterial embolization therapy, percutaneous puncture of the renal cyst, and percutaneous sclerotherapy of the renal cyst. Since these procedures are performed infrequently, in this report, we discuss mainly the endoscopic surgery for polycystic kidney disease and simple renal cyst.

　When symptoms of polycystic kidney disease such as abdominal distention, pain and infection are severe, endoscopic decortication of renal cyst is preferred. Although this procedure is comparatively easy, the aim of performing the procedure and the risk of complications should be explained to the patient thoroughly. For patients with end stage renal disease, endoscopic nephrectomy or transcatheter renal arterial embolization therapy may be performed. Endoscopic decortication of renal cyst is also selected for patients with symptomatic simple renal cyst.