転移性脊椎腫瘍に対する術前塞栓術

Preoperative Embolization of Metastatic Spinal Tumors

　Ⅰ．はじめに

　転移性脊椎腫瘍の治療の主目的は疼痛の軽減と，麻痺や感覚障害などの脊髄症状の悪化を防ぐかあるいは改善させることである．そのために放射線照射による腫瘍増殖の抑制や外科的治療が単独あるいは併用して行われる．外科的治療とは腫瘍の可及的摘出による脊髄除圧と脊椎再建であり，支持性獲得のために通常は内固定を必要とする．そして腫瘍摘出の際に問題となるのが腫瘍からの出血である．術前の腫瘍栄養血管の塞栓術は出血量を軽減させることが知られている^{2,4,6-9,11,12)}．当院で施行している術前塞栓術について検討し報告する．

　The authors reviewed their clinical experience with preoperative embolization of metastatic spinal tumors.

　Between October 2000 and September 2003,20 patients (13 men and 7 women; average age 68.3 years,range 44-82 years) underwent 24 spinal operations for 22 spinal metastatic tumors. Nineteen spinal operations (79%) were planned preoperative embolization with polyvinyl alcohol particles. In 3 cases,there was no tumor stain. Fifty percent of the C4-T2 lesions and 76% of the T3-L3 lesions were embolized preoperatively.

　The level of lesions determined which embolization procedure should be used. With C7-T2 or sacral lesions,feeding arteries were superselectively catheterized,then particles were injected via a microcatheter. With T3-L3 lesions,selective catheterization of the corresponding segmental arteries was performed. Particles were injected via 4 or 5Fr catheters. No complications were encountered during embolization.

　Embolizing from the origin of the segmental arteries is effective for reducing intraoperative blood loss because feeding vessels in the anterior part of the spinal body are able to be embolized. Preoperative embolization is not a very complicated procedure and careful catheterization can avoid complications. Based on tumor histology,size of the spinal body,depth of the operative field and operative approach,preoperative embolization can be performed with positive results.