横山 裕, 許斐 一郎, 宮嶋 哲匡, 田丸 俊三, 田中 正利

Hiroshi YOKOYAMA, Ichiro KONOMI, Tetsumasa MIYAJIMA, Shunzo TAMARU, Masatoshi TANAKA

福岡大学医学部泌尿器科学教室

Department of Urology, Fukuoka University School of Medicine

キーワード : adrenal mass, interventional ultrasound

目的：副腎の腫瘤性病変，特に偶発腫瘤の診断における超音波穿刺術の役割について検討した．対象と方法：対象は1994年9月から2002年3月末までに福岡大学病院泌尿器科を受診した副腎偶発腫瘤のうち経皮的超音波穿刺術を施行した8例で，患者の背景，腫瘤の形状，患側，内分泌活性の有無，病理組織学的検査を検討した．結果：8例中7例で目標とする病変部の穿刺が可能であり，2例が副腎嚢胞，2例が副腎皮質腺腫，3例が転移性副腎腫瘍（前立腺癌1例，肺癌1例，腎細胞癌1例）であった．両側の副腎腫瘤を認めた1例は安全な穿刺が困難で組織採取が不可能であった．全例で術後の出血や疼痛は認められず，重篤な合併症は無かった．結語：副腎の腫瘍性病変に対する超音波穿刺術にカラードプラ法を応用することにより，周囲臓器や血管の位置を明確にした上で，穿刺ラインを設定することが可能となり，出血や気胸などの合併症も無く安全に施行することが出来た．さらにカラードプラ法を含む超音波断層法は，非侵襲的にリアルタイムに観察可能なことから，穿刺による出血などの合併症の発見や経過観察にも有用である．また，他臓器悪性腫瘍からの副腎転移が疑われる場合に，経皮的な生検・吸引による病理組織学的診断で，不必要な外科手術を回避することも可能で，その有用性は高く評価出来る．

Purpose: To determine the value of interventional ultrasound (US) for adrenal masses, especially incidentally discovered adrenal masses. Methods: Demographic, clinical, and pathological data were reviewed for eight patients who underwent percutaneous US-guided puncture or biopsy for adrenal masses from September 1994 through March 2002 in our institute. Results: US-guided intervention was successfully performed for seven patients: two with adrenal cysts, two with adrenocortical adenomas, and three with metastatic adrenal tumors (one from prostate cancer, one from lung cancer, and one from renal cell carcinoma). The remaining patient had bilateral adrenal masses, and a biopsy specimen could not be obtained because safe puncture was difficult. For all patients there was no postoperative hemorrhage or pain, and no major complications were observed during the procedure. Conclusions: Interventional US using the color Doppler method for adrenal masses is a useful procedure for safe puncture to reveal the orientation of adjacent viscera and blood vessels at the puncture site and to avoid complications including hemorrhage and pneumothorax. US, including color Doppler US, is also useful for detection of complications and follow-up studies because it is noninvasive and can be used for real-time examinations. In addition, pathological examination of specimens obtained by percutaneous biopsy or fine needle aspiration is useful for avoiding unnecessary surgery in patients with metastatic adrenal masses.