上部尿路上皮腫瘍に対するBCG灌流療法の経験

Abstract

1)上部尿路上皮腫瘍4例に対し経皮的腎瘻造設後又は逆行性にBCG灌流療法を行い, 2例に有効であった. 2)腎摘となった2例には広汎に結核性病変が認められた. 3)腎摘した1例では腫瘍が腎実質内へ浸潤していた. 4)腎血流量, 腎尿管壁の薄さを考慮して, 上部尿路BCG灌流療法の際には合併症, 癌の進行に関し慎重な対処が望まれる

Four patients with upper urinary tract transitional cell carcinoma were treated with bacillus Calmette-Guerin (BCG) via a percutaneous nephrostomy tube or a retrograde ureteral catheter. A 68-year-old female and an 80-year-old male had carcinoma in situ (CIS) in the left upper urinary tract (cases 1 and 2). A man aged 47 had CIS in the left upper urinary tract, bladder, and prostatic urethra (case 3). CIS in the left upper urinary tract was identified in a woman aged 63 with chronic renal insufficiency (case 4). Two patients (cases 1 and 2) responded to this therapy. In the other two patients nephrectomy was performed due to residual tumor. There were extensive tuberculous granulomas in the kidneys. In one resected kidney (case 4) carcinoma had invaded the renal parenchyma. The reviewed literature showed that BCG perfusion therapy was effective in 71% (27 of 38 renal units) for the upper urinary tract tumors and that there were 5 cases of severe complication, including sepsis in 2, high fever in 2, and ureteral stricture in 1. Based on the fact that the kidney receives a profuse blood supply and that the renal pelvis and ureter have a thin wall, careful management is mandatory to prevent severe adverse effects and insidious tumor progression.