Testicular Lymphangiographyによる睾丸腫瘍の後腹膜リンパ節転移の診断

Abstract

T.L.後に後腹膜リンパ節郭清術を施行した20例の睾丸腫瘍患者について検討した.睾丸の第1次リンパ節に転移が認められなかった症例のT.L.では, リンパ管はL2～L4で2～6本に分岐し, 造影されるリンパ節はL1～L4の間で4～10個であった.第1次リンパ節に転移が認められた症例のT.L.では, リンパ管には造影剤の途絶や溢流, 拡張, 迂回走行及び遠位側後腹膜リンパ節への逆流などが見られ, リンパ節には全く造影されないもの, 陰影欠損, 造影されるリンパ節数の減少(2個以下), 変位及び反対側リンパ節の造影などが見られた.転移例では1症例について3～5の前記の異常所見が見られ, これらの所見が複数である場合には後腹膜転移の存在する可能性が大であると考えられた.造影剤の管外への溢流像は転移例にも非転移例にも見られたが, その頻度は転移例において高率であった.T.L.は第1次リンパ節への転移の有無を知るためには有用な検査法であるが, 2次リンパ節への転移や後腹膜リンパ節の全体像をみるためにはFoot L.の併用が必要であった

Testicular lymphangiography was performed before retroperitoneal lymph node dissection in 20 patients with testicular tumor. The clinical value of testicular lymphangiography in the diagnosis of retroperitoneal metastases was evaluated retrospectively in comparison with the findings obtained by retroperitoneal lymph node dissection. In 12 patients who had no metastasis in the primary lymph nodes of the testis, testicular lymphangiography showed the lymph vessels to be diverged into 2 to 6 vessels (mean: 3.5) at the level between L2 and L4, and 4 to 10 lymph nodes (mean: 6.2) at the level between L1 and L4 were filled with contrast medium. On the other hand, in 8 patients who had metastases in the primary lymph nodes, several abnormal findings were observed in both lymph vessels and nodes, i.e., discontinuity, extravasation of contrast medium, dilatation, displacement and reflux to the distal side in the lymph vessels, and decrease in number (less than 2), non-visualization, filling defect, displacement and contrastfilling in the contralateral side in lymph nodes. Three to 5 of these abnormal findings were usually found in each case. The extravasation of contrast medium was not a finding specific to cases with lymph node metastases, because it was also found in a few cases without metastases. Testicular lymphangiography is a valuable method to detect primary lymph node metastases from testicular tumor. However, the combination of testicular and foot lymphangiography is imperative to demonstrate wide spread lymph node involvement in the retroperitoneum.