透析患者にみられた腎細胞癌の臨床的検討

Abstract

最近10年間に腎摘出術を行い, 病理学的に腎細胞癌と診断された透析患者11例(男9例, 35～70歳, 平均54.8歳)を対象に, 臨床的特徴及び治療成績について検討した.透析期間は1～21年, 平均11.7年であった.血液透析の原疾患は慢性糸球体腎炎が5例と最も多く, 発見の契機となった臨床症状は肉眼的血尿が5例と最も多かった.手術を行った12腎中9腎は, 腰部斜切開により経後腹膜的に行い, 2例に経腹膜的摘除, 1例に後腹膜鏡下摘除を行った.輸血は術前後の後腹膜血腫の2例及び術前に貧血のあった2例に行った.病理学的伸展度は, 9例がpT1aで最も多かった.手術時間は70～373分, 中央値123分で, 出血量は80～1380ml, 中央値180mlであった.術後経過観察期間は11ヵ月～7年11ヵ月で, 1例が癌死, 2例が他因死した

Eleven patients on hemodialysis that were surgically treated for renal cell carcinomas during the recent 10 years at our institutes were clinically analyzed. Patients' ages at presentation ranged from 35 to 70 years with an average of 54.8 years. Nine of the 11 patients were males and 2 were females. Periods between the introduction of hemodialysis and the presentation ranged from 1 to 21 years with an average of 11.7 years. The most frequent cause of hemodialysis was chronic glomerulonephritis. Five patients presented with macroscopic hematuria, which was the most frequent clinical manifestation. Transperitoneal nephrectomy through a lumbar oblique incision was performed in 9 of 12 surgical procedures. Transperitoneal resection and retroperitoneal endoscopic resection were performed on 2 patients and 1 patient, respectively. Blood transfusion was performed on 2 patients with retroperitoneal hemorrhage before or after operation and 2 patients with pre-existing renal anemia. Pathologically, 9 patients had pT1a disease. Patients were followed up for up to 7 years and 11 months. One patient died of the disease and 2 patients died of unknown causes. In conclusion, surgical removal of renal cell carcinomas was well tolerated, safe and effective treatment in patients under hemodialysis.