陰茎癌骨盤内転移による膀胱直腸瘻の1例

Abstract

65歳男性.患者は11年前, 陰茎の扁平上皮癌で放射線照射・化学療法を, 5年前には陰茎亀頭部のカリフラワー状腫瘍で陰茎全摘術・陰茎再建術を受けた.今回, 閉塞性動脈硬化症で血管外科入院中, 肛門から水様液体流出を自覚し, CTでこれを確認したところ膀胱と直腸間に3cmの造影効果のある境界不明瞭な腫瘤性病変が認められた.泌尿器科へ転科となり, 逆行性膀胱尿道造影検査にて調べたところ膀胱後壁から直腸へかけて造影剤の流出が認められ, 膀胱直腸瘻と診断した.発熱と高度炎症反応より膀胱直腸瘻による尿路感染症と考え, 瘻孔切除・閉鎖術を行ったが, 膀胱三角部中央から後壁に径3cmの瘻孔を認めたため瘻孔切除・閉鎖はできないと判断し, 周囲組織を採取後尿道カテーテル挿入と膀胱瘻を造設して終了した.術後, 肛門からの尿流出は減少したが, 術後40日目に全身状態不良で死亡となった

A 65-year-old man was referred to our hospital complaining of glans induration. Tumor biopsy revealed squamous cell carcinoma. Although he was given radiation therapy and subcutaneous injection therapy of bleomycin, viable cancer cells remained. Then he was given combination chemotherapy of bleomycin and cisplatin, and paint therapy of bleomycin ointment. Local recurrence with a cauliflower-like tumor occurred five years after the chemotherapy. Then we performed total penectomy and reconstructive surgery of penis. Five years later, discharge of urine from anal appeared. Computerized tomography of pelvis demonstrated a mass 3 cm in diameter in the anterior portion of anal and cystogram demonstrated a vesicorectal fistula. We tried to perform fistulectomy, but foiled because of large fistula. Then we inserted a urethral catheter, which resulted in obstruction of fistula by its balloon, and we made a cystostomy for securing urinary tract. Pathological examination of tissue around the fistula revealed squamous cell carcinoma. His quality of life was improved, but his general condition became worse gradually and he died of cancer.