多孔性ゼラチン粒ジェルパートを用いた頭頚部腫瘍塞栓術

Preoperative Embolization for Cranio-cervical Tumors using Gelpart

Ⅰ．はじめに

　腫瘍塞栓術は摘出術時の出血を軽減したり，組織が軟化することにより摘出しやすくなるといった効果があり，頭頚部領域で広く行われているが^3,5,9)，本邦においては塞栓物質としてはコイルが認可されているのみである．多孔性ゼラチンスポンジ粒ジェルパート（日本化薬，東京；Fig. 1A）は本邦で開発され，2005年に肝細胞癌に対する塞栓物質として保険承認された．われわれは頭頚部腫瘍に対してジェルパートを用いた塞栓術を行っており，初期使用経験について報告する．

　Background: Preoperative embolization of cranio-cervical tumors is commonly used to reduce intraoperative blood loss. Gelpart is a new collagen embolic agent. Because of its porous structure, it is deformable and tends not to aggregate. The purpose of this study is to evaluate the efficacy of the Gelpart embolization for cranio-cervical tumors.

　Materials and Methods: The shape and size of Gelpart was observed under high-resolution microscope. Eight cases of cranio-cervical tumors were treated with Gelpart embolization. A microcatheter was introduced to the feeding artery and Gelpart, mixed with contrast medium, was injected manually. The effect of the Gelpart embolization was evaluated with MRI and operative specimen.

　Results: The shape of Gelpart was not spherical, but the surface became smooth after mixture with contrast medium. Gelpart injection proceeded smoothly and it resulted in excellent angiographical devascularization. No complications occurred related to the Gelpart embolization. At surgery, the tumor was soft and was removed easily. Intraoperative blood loss was relatively less than that using often method. Gelpart embolized peritumoral small arteries and induced tumor necrosis.

　Conclusions: We reported our preliminary experience of Gelpart for preoperative embolization of cranio-cervical tumors. Gelpart was effective for tumor embolization.