原発性膀胱上皮内癌の臨床的検討

Abstract

14例の原発性膀胱CIS例の臨床的検討を行った. 1)症状は頻尿, 排尿痛のような膀胱刺激症状が主であり, 尿細胞診が診断上重要である. 2)BCG膀胱内注入療法が治療の第一選択と思われるが, 一旦, CRとなっても進展の可能性は大きいので慎重な経過観察をして, 膀胱全摘除術の時期を失しないようにしなければならない. 3)進展には膀胱筋層への浸潤と共に前立腺間質への浸潤が重要である. 4)膀胱刺激症状の激しいものや, 病変が広範囲に及んでいるものは, 最初から膀胱全摘除例の適応があると思われる

In our department 14 patients with primary carcinoma in situ of the bladder were treated. Thirteen patients were male and 1 patient was female. Most of the patients complained of irritative vesical symptoms such as painful urination and/or pollakisuria. Cystoscopic examination revealed no overt tumor but some abnormal findings like localized or diffuse hyperemia or fine granular changes were noted. In 4 patients, total cystectomy was performed primarily and 10 other patients were treated at first with intravesical chemotherapy or intravesical BCG. Five of those 10 patients (50%) developed invasive cancer and total cystectomy was performed secondarily in them. Invasive cancer occurred in the bladder wall in 2 patients, in the prostate in 2 patients and in both bladder and prostate in 1 patient. Five-year and 10-year survival rates of 14 patients in this study were 66.7% and 44.4%, respectively.