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Title: 肝硬変による血小板減少症を伴う腎癌に対し,部分的脾動脈塞栓術後に腎摘出術を施行した1例
Other Titles: Surgical removal of renal cell carcinoma after partial splenic embolization in a patient with liver cirrhosis: a case report
Authors: 槙山, 和秀  KAKEN_name
仙賀, 裕  KAKEN_name
五島, 明彦  KAKEN_name
桜本, 敏夫  KAKEN_name
秦, 康夫  KAKEN_name
Author's alias: MAKIYAMA, Kazuhide
SENGA, Yutaka
GOTOU, Akihiko
SAKURAMOTO, Toshio
HATA, Yasuo
Keywords: Renal cell carcinoma
Partial splenic embolization
Liver cirrhosis
Issue Date: Dec-2000
Publisher: 泌尿器科紀要刊行会
Journal title: 泌尿器科紀要
Volume: 46
Issue: 12
Start page: 895
End page: 898
Abstract: 75歳女.腹部膨隆を主訴に来院し,精査目的で緊急入院となり,CTで脾腫と多量の腹水を伴う肝硬変と診断され,同時に左腎上極に5.5cm大の腫瘤を認めた.肝硬変はウイルス性,アルコール性ともに否定され原因不明で,Child分類はBであり,上部消化管内視鏡で噴門部から食道上部まで連続し発赤所見を伴う連珠状静脈瘤を認めた.腹水による腹部膨隆,下腿の浮腫,眼瞼結膜に貧血を認めたが黄疸は認められなかった.左腎摘除術の適応と考えたが血小板数が少ない為,まず部分的脾動脈塞栓術を施行した結果,術直後より血小板数は上昇し,腎摘除術前日(塞栓術後第70病日)には12.4×10^4/mm3に,ヘモグロビンは12.7g/dlに上昇した.食道静脈瘤に対しては内視鏡的静脈結紮術を2回施行した.経腰的アプローチで左後腹膜腔に達し左腎を摘出した.病理組織学的所見で腎細胞癌はclear cell carcinoma,G2,INFβ,pT1と診断された.術後13日目に退院となり,術後8ヵ月の現在再発は認めていない
Partial splenic embolization is used to treat patients with liver cirrhosis accompanied by hypersplenism for improving thrombocytopenia and leukopenia. We report a case in which partial splenic embolization was used before nephrectomy because both renal cell carcinoma and liver cirrhosis were present. A 75-year-old woman visited our hospital complaining of abdominal distension. Computed tomography revealed a 5.5 cm left renal tumor. Liver cirrhosis, ascitis, splenomegaly was observed. Blood tests revealed pancytopenia; platelet count was 2.9 x 10(4)/mm3. The patient was treated by partial splenic embolization in an attempt to ensure a safe nephrectomy. After the embolization, her platelet count increased immediately to 19.2 x 10(4)/mm3, and left nephrectomy was performed successfully.
URI: http://hdl.handle.net/2433/114425
PubMed ID: 11211807
Appears in Collections:Vol.46 No.12

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