高齢膀胱癌患者に対する膀胱全摘除術および尿路再建法の臨床的検討 - 代用膀胱造設に関して -

Abstract

75歳以上の膀胱全摘19例に臨床的検討を加え, 若年症例と比較した. 1)手術時間, 出血量, 術後合併症などは, 若年症例と比べて同等以下であった. 2)術後在院日数は若年症例よりも短い傾向であり, 膀胱再建を行っても入院期間の延長はみられなかった. 3)予後は若年症例と同等であり, pT3b以上は不良であった.膀胱再建症例では予後が良好な症例を選択しえた

We compared the clinical and functional results of radical cystectomy and urinary reconstructions performed on 19 elderly bladder cancer patients over 75 years old to those on 22 younger patients to determine whether age was one of the critical points for the application of this type of surgery. Between January 1992 and January 1998, bladder substitution was performed after cystectomy using either the Hautmann, Studer or Reddy procedure in 9 of the 19 elderly patients. Urinary diversion was performed after cystectomy using ileal conduit and ureterocutaneostomy procedures in the rest of the patients. On the other hand, bladder substitutions were performed in 11; urinary diversions with continent urinary reservoir in 6 and with ileal conduit in 4 of the 22 younger patients. Neither prolongation of the operation time, nor increase in the amount of bleeding or prolongation of the post-operative hospitalization period was observed in any procedure used for elderly patients in comparison with younger ones. In elderly patients, the average operation time of radical cystectomy with bladder substitution was slightly longer than that of total cystectomy with ileal conduit or ureterocutaneostomy. The post-operative hospitalization period in the case of bladder substitution was similar to that for ileal conduit and ureterocutaneostomy with the difference of only 5 days on average. There were no peri-operative deaths, and early post-operative complications were observed in 3 of 9 cases of the bladder substitution, in 4 of 10 cases of ileal conduit or ureterocutaneostomy. Five cases of bladder substitution maintained their comfortable voiding urine comfortably, while 4 had dysuria and/or urinary incontinence. Over all, late complications occurred in 10 of the elderly patients. The rate and types of complications in the elderly patients were not different from those in the younger patients. The cause-specific survival rate and overall survival rates of the elderly patients were similar to those of the younger patients. In conclusion, indication of cystectomy and selection of urinary reconstruction procedure are not dependent on patient's age, Orthotopic urinary reservoir was found to be useful for even an elderly patient.