泌尿器科領域における人工的動脈栓塞法の経験 -効果判定からみた適応症について-

Abstract

Transcatheter artificial embolization was therapeutically carried out in 26 patients with renal cell carcinoma, in 3 with secondary metastatic renal tumor and in 2 with intractable bladder hemorrhage. Effects of embolization were evaluated from the clinical points as follows: i) cessation of blood flow, ii) improvement of clinical symptoms, iii) embolization effects seen in the extirpated kidney and its pathological findings, and iv) patient's survival. Subjective evaluation of embolization was also performed from both sides of patients and physicians. Although cessation of blood flow can be observed on the arteriogram after embolization, 99mTcDMSA renal scintigraphy is an useful adjunct for detecting renal blood flow serially. Recannalization of embolized arteries often Dccurred around 2 months after embolization. There are two modes in recurrence. One is recannalization, the other is a neovascularity of the tumor in the area where embolization did not extend in the previous treatment. Disappearance of hematuria was the most prominent aspect in improvement of clinical symptoms. Embolization effects could be seen in the extirpated kidney and its histological findings. However, tumor necrosis was noticed only partly and intact tumor portions were always found in the histological examination. Embolization itself did not always exert good effect on the surgical procedure or the patient's survival. There was a good coincidence of 60% between subjective evaluation of embolization in patients and that in physicians.