体外循環を用いて外科的治療を行った下大静脈内腫瘍血栓を伴う腎細胞癌の3例

Abstract

下大静脈内腫瘍血栓を伴う腎細胞癌3例で体外循環下に腎摘及び腫瘍血栓摘出を行った.術前, CT, MRI及び下大静脈造影により腫瘍血栓のレベルを決定した.腫瘍血栓は, 1例では右房, 2例では肝静脈の上方まで発育していた.腫瘍血栓が右房まで発育していた1例は術後5ヵ月に腎細胞癌の多発転移で死亡した.肺転移があった1例はインターフェロンαを投与し, 術後5ヵ月生存している.残り1例は術後7年の現在再発, 転移の徴候もなく健在である

Three cases of renal cell carcinoma with tumor thrombus extending into the inferior vena cava are reported. Radical nephrectomy and thrombectomy were performed under extracorporeal circulation in all the cases. The level of tumor thrombus was preoperatively determined by computed tomography, magnetic resonance imaging or venacavography. The tumor thrombus extended into the right atrium in one, and above the hepatic vein in two cases. One patient whose thrombus reached the right atrium died of multiple metastasis of renal cell carcinoma 5 months after operation. Another patient with lung metastasis was given interferon-alpha and is alive 5 months after operation. The other patient is clinically free of disease and in good health 7 years after operation. We believe that extracorporeal circulation allows an opportunity to resect the tumor thrombus in a controlled situation, and makes the operation safer.