腹腔鏡下副腎・腎手術における血管損傷の予防と対処法

Vascular Injury and Its Management in Laparoscopic Adrenal and Renal Surgery

　腹腔鏡下副腎・腎手術で生ずる血管損傷について述べた．腹腔鏡下副腎摘除術における血管損傷の頻度は約2％，また腹腔鏡下腎摘除，根治的腎摘除術では3〜6％と報告され，約半数で開腹手術での修復，止血がなされていた．副腎，腎臓は腎動脈，腎静脈，大動脈，下大動脈などの大血管と解剖学的に近接しており，これらへの外科手術では大血管への操作が必要となってくる．腹腔鏡下手術では器具なども含めて手術操作に制限があるため，より注意深い操作を行い，血管損傷を避けることが重要であることを述べた．

Vascular injury during laparoscopic adrenal and renal surgery were reviewed. Its prevention and treatment were described. The incidence of vascular injury was 2% in laparoscopic adrenalectomy and 3 to 6% in laparoscopic nephrectomy and radical nephrectomy. One half of these injuries were treated laparoscopically and the other were treated with open procedures. Vascular injury during laparoscopic surgery is the most amenable complication, which often requires conversion to open surgery. In adrenal and renal surgery, the great vessels such as the renal artery and vein, vena cava and aorta are involved.