LAPAROSCOPIC SURGERY FOR UROLOGICAL CANCERS : RESEARCH INTO ITS EFFICACY AND SAFETY

为了建立有效和安全的泌尿系肿瘤的腹腔镜手术，本研究开发了以下程序。首先，针对泌尿生殖系统恶性肿瘤发展了有用的腹腔镜手术，包括肾癌的肾部分切除术，肾癌、肾癌和输尿管癌的肾输尿管切除术，前列腺癌的根治性前列腺癌切除术，以及回肠新膀胱癌的全膀胱切除和膀胱肿瘤的部分膀胱切除术。根据移植癌细胞的动物实验结果和手术前后采血中癌细胞的RT-PCR分析结果，癌细胞通过气腹扩散的风险是有限的。术前、术后测定血BNP时，气腹对心功能的影响有限。从术后恢复和伤口疼痛等临床参数来看，腹腔镜术比开腹手术侵袭性小。作为反映手术侵袭性的生化指标，术后第1天血清IL-6水平和术后血清T3、CH50水平均下降。在根治性肾切除和前列腺切除术中，根据这些生化指标，认为腹腔镜手术比开腹手术侵袭性更小。

To establish effective and safe laparoscopic surgeries for urological cancers, this study developed the following procedures. First, useful laparoscopic procedures for urogenital malignancies were developed, including a partial nephrectomy for renal cancer, a nephroureterectomy for renal, pelvic and ureteral cancers, a radical prostatectomy for prostate cancer, and a total cystectomy with ileal neobladder formation and partial cystectomy for bladder tumors. According to the results from animal experiments using cancer cell implantation and RT-PCR analysis of the cancer cells in pre- and post-operative blood sampling, the risk of dissemination of the cancer cells by a pneumoperitoneum was limited. The pneumoperitoneum had limited effects on cardiac function when blood BNP was analyzed pre- and post-operatively. According to clinical parameters including post-operative recovery and wound pain, laparoscopic surgery is less invasive than open surgery. As biochemical parameters of surgical invasiveness, the serum levels of IL-6 on post-operative day 1, and post-operative decreases in the serum T3 and CH50 levels were demonstrated. In the radical nephrectomy and prostatectomy, the laparoscopic surgeries were considered to be less invasive than open surgeries according to these biochemical parameters.