腎細胞癌の骨盤骨転移に対し半骨盤切除術を施行した2例

Abstract

症例1:49歳, 男性.右腎細胞癌, 骨盤骨転移が認められた.1997年4月根治的右腎摘出術を施行, renal cell carcinoma(tubular type, grannlar cell subtype, INFγ)であった.症例2:33歳, 男性.1996年7月左腎細胞癌で根治的左腎摘出術を施行, renal cell carcinoma(tubular type, granular cell subtype, INF-α)であり, 1997年5月左骨盤腫瘍を認め骨転移が認められた.両症例とも他に腫瘍が及んでいないことを確認, 症例1では術前左内腸骨動脈をコイルを用いて塞栓, 症例2でも栄養血管を塞栓させ, 骨盤骨の転移巣に対し下肢の切断も併用した半骨盤切除術を症例1で1997年7月, 症例2で1997年8月に施行された.術後経過は両症例とも良好で装具を用い歩行, 車の運転も可能である.INF-αによる免疫療法を行い, 症例1は再発を認めてないが, 症例2は左腎床腎内部及び肝臓に多発性転移を認めている

Two patients, one with and one without a history of nephrectomy for renal cell carcinoma, presented with lower abdominal pain. One of them, a 49-year-old man, had tumors in the right kidney and the right ischiadic bone. He underwent nephrectomy and pathologic findings showed renal cell carcinoma (tubular type, granular cell subtype, INF-gamma, G2). The other patient, a 33-year-old man with a previous history of left nephrectomy for renal cell carcinoma (tubular type, granular cell subtype, INF-alpha, G2), was found to have a large tumor in the pelvis, extending from the pubic and iliac bones to the hip joint. Both patients underwent embolization of the hypervascular mass using a vascular coil followed by hemipelvectomy under general anesthesia. The pathology reports confirmed bone metastases from renal cell carcinoma. Both patients survived surgery and their postoperative courses were uneventful without urinary or bowel incontinence. However, impaired potency was noted in the latter case. Immunotherapy with INF-alpha was resumed immediately after surgery.