腎血管筋脂肪腫に対する手術および経過観察症例の比較検討

Abstract

画像診断又は摘出標本より病理組織学的に腎血管筋脂肪腫(AML)と診断した23例を対象とし, 手術施行群9例と経過観察群14例とに分類した.手術施行群の術前診断や, 両群間における男女比, 年齢, 腫瘍発生側, 腫瘍サイズなどを中心に比較検討した.AMLの診断にはCT scanでの脂肪成分の検出が重要であるが, 腎癌との鑑別を更に向上させるため, 微少な脂肪組織を検出する工夫が必要であった.1cm以下のAMLは経過観察のみで対応可能と考えた.5cm以上や増大傾向のあるAMLでは, 外科的処置が必要となる推察した

Twenty-three patients (6 men and 17 women) with renal angiomyolipoma (AML) were analyzed. They were divided into two groups; 9 patients in the operated group and 14 patients in the surveillance group. The operations for AML were performed on 3 patients suspected of having renal cancer or 6 patients with an AML more than 5 cm in size who had some symptoms as a result of the presence of the tumor. The patients in the surveillance group had tumor less than 4 cm in diameter, and did not have any symptoms. No changes in tumor size were observed during the intervals between observation checkups. The male to female ratio, the average age and the location of AML were not significant in either group. However, the tumor size was significantly larger in the operated group. Thus, the tumor size is considered to be an important factor when deciding the necessity of surgical treatments for AML. Pre-operative diagnosis and treatment strategies, including thin-section computed tomography and selective arterial embolization for AML were discussed.