腎細胞癌における腎動脈塞栓術

Abstract

腎細胞癌58例中18例に腎動脈閉栓術を施行した.18例中初期の10例はADMまたはMMCをone shot injection後にGelfoam, steel coil (G群)を, 最近の8例はabsolute ethanol (A群)を用い塞栓した.1) A群は塞栓物質注入直後に激痛(6/8, 75%)をきたすが帰室後は自制可能であった.G群の直後はほとんど疼痛を訴えないが徐々に強くなり嘔気, 嘔吐をともない, そのために手術を早めざるをえなかった.2)発熱はA群の方がG群より有意に高かった.3) WBC, GOT, GPT, LDHは塞栓2～3日後に一過性の高値を示すが両群間に有意差はなかった.γ-GTP, ALPは緩徐に上昇傾向を示した.4)寄生動脈の豊富な, または局所浸潤があきらかな腎細胞癌には塞栓効果はあまり期待できない.5)組織学的に腫瘍組織と正常腎組織の梗塞性変化はA群の方が強く, 塞栓物質はabsolute ethanolの方がすぐれている.6)高度な梗塞性変化は病理組織診断を困難にすることもある.7)塞栓術は腎細胞癌の予後に好影響はなかった.8)塞栓術は手術操作(腎茎処理)を容易にするが, 単にその目的に絞れば塞栓物質は必ずしも多量を要しない

Renal arterial embolization is often used in the treatment of patients with renal cell carcinoma, either preoperatively to facilitate nephrectomy or as palliative therapy in advanced cases. Eighteen patients (18/58; 31%) underwent renal arterial embolization in our department since 1979, initial 10 cases with Gelfoam and steel coil (group G) and recent 8 cases with absolute ethanol (group A). Clinical studies of daily changes of symptoms and blood chemistry in both groups after embolization were compared and the results were as follows: Severe flank pain was noted immediately after embolization but thereafter well controlled without analgesics in group A. The patients in group G experienced no pain during the procedure of embolization but have had moderate flank pain of two or three days' duration with nausea and/or vomiting and required surgical procedure within a few days after embolization. Post embolization fever in group A was described as higher than that in group G significantly. Leukocytosis was noted to be persistent for up to seven days and blood chemistry showed transient marked elevations of GOT, GPT and LDH immediately after the procedure without significant value in both groups. Embolization to advanced tumor with many parasitic vessels or massive local invasion may not always be available for remaining of viable-appearing tumor cells in venous lumen, as if palliative treatment. Absolute ethanol may be more useful as the embolizing substance than Gelfoam and steel coil by reason of producing wide severe infarction of diseased kidney. Broad marked infarction due to renal arterial embolization may make pathological diagnosis difficult. Immunological effects of renal arterial embolization were not observed in short term patients survival.(ABSTRACT TRUNCATED AT 250 WORDS)