同時性両側性腎細胞癌に対する二期的腎保存手術 : 1症例の経験

Abstract

遠隔転移を認めない同時性両側性腎細胞癌に対して二期的に腎保存手術を行った.先に右腎腫瘍に対して核出術を行い, 後にstage進展度の高い左腎腫瘍に対して根治的腎摘除術を行った.二期手術後の血清クレアチニン値は1.2mg/dl, 24時間クレアチニンクリアランス 48.9ml/minであった.術後CTで明らかな腫瘍の局所残存は認めず, 術後9ヵ月現在, 腫瘍の再発, 転移を認めていない

We present a case of synchronous bilateral renal cell carcinoma successfully treated with preservation of renal function. A 68-year-old man was admitted with complaints of gross hematuria and left back pain in February 1994. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a round mass 5 cm in diameter in the middle posterior portion of the right kidney and another one 7 cm in diameter in the upper pole of the left kidney. At first the right renal mass was enucleated in situ with a temporary vascular occlusion under surface cooling. Left radical nephrectomy was followed after confirmation of functional recovery of the right kidney on the 20th postoperative day of the first operation. Histopathological examination of the surgical specimens revealed that both masses were renal cell carcinoma, alveolar type, clear cell subtype. The pathological stage of the right and left renal cell cancer was pT2 and pT3a, respectively. The patient retained good renal function, with a serum creatinine concentration of 1.2 mg/dl and has been free of disease for nine months after the second operation.