生体腎移植後に腹腔鏡手術を行った2症例

抄録

  We report 2 patients with history of prior renal transplantation who underwent laparoscopic myomectomy or hysterectomy.

Case 1: A 43-year-old woman (gravida 0) underwent living related renal transplantation when she was 38 years old to treat chronic renal failure secondary to IgA nephropathy. She reported history of a uterine myoma, which had gradually enlarged to measure greater than the size of a newborn's head when she presented at the age of 43 years. Because of a sensation of lower abdominal fullness, she underwent laparoscopic myomectomy after receiving gonadotrophin releasing hormone (GnRH)-agonist therapy. A 3-port laparoscopic myomectomy was performed (an umbilical trocar and 2 parallel trocars on the patient's left side). The estimated blood loss was 500 mL, and the operation time was 224 min.

Case 2: A 45-year-old woman (gravida1 para 0) underwent living related renal transplantation when she was 43 years old to treat chronic renal failure secondary to vesicoureteral reflux. She reported history of uterine myomas and adenomyosis that had enlarged and presented with hypermenorrhea and dysmenorrhea. She underwent laparoscopic hysterectomy with the insertion of ureteral stents after receiving GnRH agonist therapy. A 4-port total laparoscopic hysterectomy was performed (an umbilical trocar and 3 lower quadrant trocars). The estimated blood loss was 690 mL, and the operation time was 217 min.

  In both patients, immunosuppressants and steroid were continued perioperatively, and acetaminophen was used for postoperative pain control. Intraoperatively, pneumoperitoneum was established to a pressure of 8–10 mmHg, and urine volume was maintained perioperatively. Both patients were discharged from the hospital on postoperative days 5 and 6, respectively.