上顎洞血瘤腫に対して低濃度NBCAを用いて術前塞栓術を行った1例

Preoperative Embolization for Organized Hematoma of the Maxillary Sinus with Low-concentration n-butyl-2-cyanoacrylate:A Case Report

Ⅰ．はじめに

　血瘤腫（organized hematoma）は，上顎洞を中心とした副鼻腔に発生する易出血性良性腫瘤の総称であり¹⁶⁾，耳鼻咽喉科領域で主に治療される疾患である．鼻閉感や鼻出血の自覚症状を伴い，画像所見から悪性腫瘍との鑑別が問題となる．比較的稀な疾患ではあるものの，摘出時には大量出血を起こす可能性もあり，当該科より術前塞栓術を依頼されることがある．

　今回，われわれは上顎洞に発生した血瘤腫に対して，低濃度n-butyl-2-cyanoacrylate（NBCA）による術前塞栓術が有用であった症例を経験したので，これまでの報告に若干の文献的考察を加え報告する．

　Organized hematoma is a rare, non-neoplastic, and hemorrhage-prone condition that requires attention due to the risk of intraoperative bleeding. Preoperative embolization was performed to ensure intraoperative hemorrhage control. Here, we report a case of preoperative embolization of an organized hematoma using a low-concentration of n-butyl-2-cyanoacrylate（NBCA). An 80-year-old male presented with a 2-month history of repeated nasal bleeding and nasal obstruction. Diagnostic imaging revealed a mass measuring 3.7 cm in the right maxillary sinus with thinning of the surrounding bone. This was diagnosed as an organized hematoma with a biopsy. As a preoperative treatment, embolization of the main feeding artery was performed through the external carotid artery, using a low concentration of NBCA（5%). When the NBCA cast had reached the organized hematoma, as observed on plain CT, endoscopic sinus surgery was performed, and the organized hematoma was resected without significant bleeding. Preoperative embolization of the organized hematoma with low-concentration NBCA was useful to prevent heavy intraoperative bleeding.