単腎患者の多発性腎癌に対するMicrowave tissue coagulatorを用いた無阻血核出術の1例

Abstract

67歳男.左腎盂癌に対して腎尿管全的術を施行し経過観察中であった.腹部CTで右腎上極と下極に腫瘤を認めた.右多発性腎腫瘍と診断し, 入院した.画像所見等から腎保存術適応と考え, 無阻血腎核摘出術を施行した.術後に有意な腎機能低下は認められなかった.術後2ヵ月目の造影CTでは核出部は造影効果がなく低吸収域となっているが, 術後18ヵ月目でのこの低吸収域部は萎縮し, 以降は著変を認めなかった.術後経過は特に合併症もなく良好で, 術後約2年経った現時点での再発, 転移を認めていない

A 67-year-old man, who had undergone left nephroureterectomy for ureteral tumor (transitional cell carcinoma, G1) eight years previously, was found to have two renal tumors in the residual right kidney by the follow-up computed tomography (CT). We performed non-ischemic enucleation for multiple tumors at the upper and lower pole in the unilateral kidney using a microwave tissue coagulator (MTC). We confirmed by means of ultrasonography during operation the absence of any other satellite tumors. The operation time was 154 minutes and bleeding during operation was 267 ml. There was no difference between creatinine before (0.73 mg/dl) and after (0.79 mg/dl) operation. On the follow-up CT, there was a low density area after enucleation. This area gradually decreased and disappeared on enhanced CT 18 months after operation. We enucleated multiple renal cell carcinomas using MTC without reduction of renal function or remarkable side effects. These results suggested that non-ischemic enucleation using MTC would be useful for multiple renal cell carcinoma in the unilateral kidney.