所謂特發性腎出血に關する研究 第1篇:所謂特発性腎出血に関する臨床的統計的観察

Abstract

1)京都大学医学部泌尿器科に於ける昭和6年より昭和27年に至る満22年間の所謂特発性腎出血の臨床的統計的観察を述べた.2)所謂特発性腎出血患者総数は209例にして膀胱鏡検査を施行した泌尿器科患者総数の約2%に当り, 此の中男子133例, 女子76例と男子は女子の約2倍である.3)年令の最低は男子16才, 女子21才, 最高は男子77才, 女子68才で, 血尿初発時の年令的分布に就いては21～60才の間は各年代に於て大差なく, 20才以下又は60才以上は少く.全例の3/4は50才以前に1血尿が初発している.4>患側は男女とも左側に多く両側は甚だ少い, 5)全例の1/2は血尿発見より2運間以内に診察に訪れたが, 残りの半数は1・ケ月から1年余にわたつて放置していた・6)主訴は血尿のみのもの80・4%でi全例の約1/5が血尿の他に何等かの自覚症状を伴つた・7)合併症は甚だ少ぐ, その主なるものをあげれば膀胱炎11例, 妊娠5例・両腎下垂4例等で, 既往症として多いものは淋疾31例, 肋膜炎25例, 肺浸潤16例等である・8)全例の17・7%に強いて誘因と思われるものが見出せたが, 大部分は全く突然に血尿の出現を見た・9)既往に血尿を見たものは62例(29・3%)にして, この中1回のもの33例(532%), 2回12例(19・4%), 3～5回12例(19.4%), 6～10回2例(32%), 11～20回2例(3・2%), 不明1例である・10)腎触診所見としては左右何れの出血に於ても大略1/4に両腎を触れ, 患側腎の触知は右腎出血で63.9%, 左腎出血で29.9%と右側に多く.腎部に圧痛を訴えたものは右腎出血18.1%, 左腎出血11・7%である.11)初診時に於ける尿所見は全例の4/5にかなりの出血を来たしていて, 赤血球以外の他の要素を認めたものは甚だ少い.12)膀胱鏡所見は膀胱粘膜正常のもの171例(81.8%)にして, 認めた変化の主なるものは肉柱形成35例, 溜濁25例, 発赤12例, 三角部の発赤26例, 溜濁9例, 異常8例, 静脈怒張5例等である, 13)インヂゴカルミン排出時間は大部分は患側の如何を問おず左右略々大差なく, 腎機能は正常の範囲内にあつた.14)フェノールフタレェイン試験は3時間値で30%以下はなく.4/5は50%以上にして43例の平均は64.9%であつた.15)血液像に就いては軽度の貧血以外に仁平一所謂特発性腎出血に関する研究63著変なく、血圧, 血沈, 出血時間, 血液凝固時間, 血小板数等を測定した症例は何れも正常の範囲内にあつた・16)自律神経系の薬理学的検査を行つた13例は全例とも交感, 副交感神経の両系統或はその何れかに陽性反応を示した.17)治療に関しては止血剤の内服或は注射のみでは効果は比較的少く, 沃度ナトリウム及び硝酸銀溶液の腎孟内注入との併用が最も効果的であつた.手術例は腎被膜剥離術2例, 腎摘出術7例の計9例である.18)全例の約1/3に血尿の再発があつたが予後は比較的良好である・但し少数例ながら後になつて腎疾患の判明してくるものがあるから一定期間注意深い観察を続ける事が必要である.(文献は最終編に譲る)

This paper is a clinical analysis of 209 cases diagnosed as essential hematuria at the Urological Clinic, Kyoto University during the 22 years from 1931 to 1952. The number of cases of essential hematuria amounts to 209 (2%) in 10527 urological patients were cystoscopic examination was performed. There were 133 males and 76 females in this series and in 117 cases (56%) bleeding occured meal from right kidney, in 83 (39.9%) from left kidney and in 9 (4.1%) from both sides. In one half of the cases the onset of hematuria occured between 20 and 40 years of age. The bleeding in essential hematuria is for the most par symptomless and the urological examination proved no changes without bleeding. The general health is usually not affected by the loss of blood. The degree of hematuria at the time of the original examination is reported as follows 109 cases (52.2%) were marked, 57 (27.29%) were moderate and 38 (18.2%) were slight. In the cystoscopic examination, 171cases (81.8%) revealed normal vesical mucosa and vesical trabecula, hyperemia, venous dilatation, trigonal anomaly, etc. were found in the other cases. In the indigocarmin test 197 cases revealed normal renal function. The phenolsulphonphthalein test was made in 43 cases; it was never below 30 percent, and averaged 64.9 percent. Twenty-seven cases in which blood examinations were performed revealed no changes other than slight anemia. In 18 cases blood pressure reading averaged 128 systolic and 79 diastolic. Studies of 13 cases with particular attention to blood platelets, coagulation time, bleeding time and the history of bleeding in other areas proved no changes. In 13 cases pharmacological examination of the autonomic nerve system were performed, and all of these cases revealed positive reaction either sympathically or arasympathically. Operative procedures have been used in 9 cases, 2 were decapsulation and 7 were nephrectomy. Nephrectomy is the only operation ever indicated, and that only as an emergency measure to save a patient from bleeding to death. It is not a routine measure for intermittent hematuria over a long period. The non-operative methods have been used with success. These have consisted of intrapelvic injection of silver nitrate, of bleed transfusion and of oral administration or injection of hemostatic preparation. Of these the intrapelvic methodes combined with hemostatic preparation have given the best results, and it is of interest to note that in a large number of the cases of the series the urine had become clear within a week or 10 days after this form of treatment. In the 209 cases who have been followed from one year to 19 years there have been 62 cases with recurrences of hematuria, and in two cases renal tuberculosis developed 4 and 6 years later and nephrectomy was performed. In one case renal calculi developed 2 years later and a small stone was removed by pyelolithotomy. Prognosis in essential hematuria is favorabl in spite of the loss of blood and the recurrences of hematuria.