経皮的腎嚢胞穿刺による95%エタノール注入療法 第2編: 臨床成績の検討

Abstract

21症例22腎嚢胞に対して, 超音波ガイドによる経皮的な腎嚢胞穿刺と嚢胞再発防止のための95%エタノール注入をおこなった.1)エタノール注入後3ヵ月～2年4ヵ月(平均12ヵ月)のfollow-upで, 超音波断層検査上, 嚢胞性病変は全例に消失し, CT上, 嚢胞の著明な縮小と嚢胞壁の肥厚を認めた.2) IVPと99mTc-DMSA腎シンチグラム上, 穿刺側で形態的には著明な改善を認め, 機能的にも僅かではあるが, 有意にDMSA腎摂取率の増加を認めた.3)副作用として, 穿刺注入操作にともなって, 1例にカテーテル先端の断裂, 残存を認めたが, 他には重篤なものはなかった.注入エタノールによる局所刺戟症状を全例に, 約半数に熱感～酒酔い感を訴えたが, いずれも一過性であった.1例にエタノール注入後Cephem系抗生物質の使用によりアンタビュース様作用が出現した

Ultrasound-guided renal cyst puncture was performed on 22 cysts which were then 95% ethanol instilled to prevent recurrence of cystic fluid. Cystic lesions disappeared on the ultrasonogram in the follow-up period of 3 to 28 months. On CT, cystic lesions became smaller size but did not disappear. Average CT numbers of the cyst were 8.75 +/- 3.83 before and 12.96 +/- 3.27 after ethanol instillation. The cystic wall became thicker. Caliceal distortion and/or pelvis compression by cystic lesions improved on IVP 2 to 3 days after ethanol instillation. The renal image on Tc-99m-DMSA scintigram showed morphological improvement and DMSA renal uptake rate increased slightly but significantly 2 to 4 weeks after ethanol instillation. There were no major complications with this procedure except for one case in which the tip of the catheter became stuck in the cyst and broke off when the catheter was removed. A slight local irritable pain was noticed in all cases. Half of the patients had hot flushes and/or somewhat drunken sense but these symptoms were only temporary. Antabuse phenomenon appeared in one case with concomitant use of a cephem antibiotics after ethanol instillation. This method of therapy is a safe non-surgical approach to treat renal cysts. 95% ethanol instillation in the cyst seems to prevent recurrence of cystic fluid.