後腹膜腫瘍6例に対する腹腔鏡下手術の経験―腹腔鏡下例および開腹移行例の検討―

Outcomes of laparoscopic treatment for retroperitoneal tumors in 6 cases

◆要旨：2006年1月～2009年6月に当科で経験した647例の腹腔鏡下手術症例のうち，後腹膜腫瘍（神経鞘腫2例，奇形腫1例，皮様囊腫1例，悪性リンパ腫1例，後腹膜平滑筋肉腫1例の合計6例）について術式，手術時間，術後経過を検討した．腫瘍径は20～45mm．完全腹腔鏡下で摘出したものは3例で平均手術時間112分，hand assisted laparoscopic surgery（以下，HALS）併用例は1例で手術時間は248分であった．ほかの2例は開腹手術へと移行し，そのうちの1例は腎静脈壁浸潤のため腎静脈合併切除を要した．全例に術後合併症は認めず，術後平均在院日数は9.7日であった．後腹膜腫瘍に対する腹腔鏡治療は低侵襲で回復も早く，有用であるが，出血や他臓器損傷に対する予防や術中に悪性疾患が疑われた場合には腫瘍細胞の播種防止を念頭に置いた術式を選択することが肝要である．

　Among 647 patients who received laparoscopic surgery at our facility between January 2006 and September 2009, the outcomes in 6 patients with retroperitoneal tumors were investigated. Among 6 patients, 2 had neurilemmoma, 1 teratoma, 1 dermoid cyst, 1 malignant lymphoma, and 1 retroperitoneal leiomyosarcoma. The tumor diameter was between 20 and 45 mm. The tumor was removed only by laparoscopic surgery in 3 patients, and mean operation time was 112 minutes. In one patient, hand assisted laparoscopic surgery was combined, and operation time was 248 minutes. In two patients, laparoscopic procedure was converted to laparotomy. One of them had tumor invasion to the renal venous wall, and required excision of tumor together with the renal vein. No patients experienced postoperative complications, and the mean hospital stay was 9.7 days. The laparoscopic treatment for retroperitoneal tumors was less invasive, improved recovery time, and was useful, but it required rapid conversion to laparotomy in cases of tumor invasion.