膀胱全摘術後の両側上部尿路に再発し腎瘻周囲腹壁への浸潤を認めた移行上皮癌の1例

Abstract

33歳男の膀胱全摘除術, 回腸導管造設術後に両側上部尿路と回腸導管内に再発し, 腎瘻周囲の腹壁に浸潤した移行上皮癌例.膀胱全摘術後の経皮的腎盂穿刺による上部尿路の諸検査では尿が漏れ, そのため移行上皮癌を散布する危険性があることを強調した

A case of recurrence of transitional cell carcinoma in bilateral upper urinary tracts and ileal conduit with invasion in the abdominal wall around nephrostomy after total cystectomy is presented. A 33-year-old man with right nephrostomy, after total cystectomy, construction of ileal conduit, bilateral partial ureterectomy and left nephrectomy for transitional cell carcinoma at another hospital was referred to our hospital because of further recurrence in the right renal pelvis and ileal conduit. He had had left nephrostomy before the left nephrectomy was performed. Right nephrectomy and total extirpation of ileal conduit were performed and hemodialysis was started from the day after the operation. However, several weeks later, transitional cell carcinoma was detected pathologically in the left abdominal wall around the left nephrostomy which had been inserted. The renal pelvis was inferred to have leaked urine around the nephrostomy and invasion arose in this region. After radiation therapy he was discharged but he died from recurrence of carcinoma 9 months after the operation. After total cystectomy, examinations by percutaneous puncture of the renal pelvis are very effective for evidence of recurrence in the upper urinary tract. However, we emphasize that the percutaneous technique carries the risk of tumor invasion through the percutaneous urinary tract.