大量蒸留水灌流による表在性膀胱癌の術中播種阻止の検討

Abstract

初発表在性膀胱癌22例を対象に経尿道的膀胱腫瘍切除(TURBT)直後より長時間の大量蒸留水灌流を行ない, その術中播種阻止効果について検討した.コントロール群(腫瘍背景因子が一致している過去のTURBT症例)と比較した結果, 膀胱癌の1年非再発率は蒸留水灌流群が45%, コントロール群が65%で, 2年非再発率は蒸留水灌流群が45%, コントロール群が45%と, 両群間で有意差は認められなかった.以上より, 再発予防に蒸留水灌流の有効性は認められず, その再発メカニズムとして術中播種の頻度は低く, その他の要因(残存腫瘍)の頻度が高いことが推測された

A previous study indicated that distilled water could prevent bladder tumor cell implantation in an in vitro assay. We investigated whether a large amount of distilled water irrigation prevented recurrence of superficial bladder cancer in the clinical setting and then we estimated whether cancer cell implantation at the time of transurethral resection is a major mechanism of recurrence. Between May 2000 and January 2002, 22 patients with primary, superficial bladder carcinoma who underwent transurethral resection of bladder tumors (TURBT) were enrolled in this study. The patients underwent bladder washout with 1, 000 ml distilled water immediately after TURBT, and then intravesical irrigation with 3, 000 ml water for three hours. Control patients were randomly chosen from those who previously underwent TURBT in our hospital and had similar prognostic factors. The 1- and 2-year recurrence-free rates in the patients undergoing distilled water irrigation were both 45% and those in the control patients were 65% and 45%, respectively. There were no significant differences between the two groups. This result indicates that distilled water was ineffective in preventing recurrence of superficial bladder tumor.