職業性尿路腫瘍 和歌山市における現況と臨床的検討

Abstract

和歌山市は染料工場が多く, 染料中間物benzidine, β-naphthylamineの製造に従事した1083名中103名(9.3%)に尿路腫瘍が発見され, 初発部位は膀胱91例, 腎盂2例, 尿管5例, Papillomatosis 5例であった.病理学的に未分化癌5例, 他はすべて移行上皮癌であった.発病年齢は平均54歳, 平均潜伏期間は23年, 被曝潜伏期間が長くなる程, 潜伏期間は短くなる傾向がみられた.腫瘍発見動機別に尿パパニコロー法による検診群と自覚症状群に分類して比較した.初回治療として膀胱全摘除術が必要とされた頻度は, 自覚症状群に比して検診群で有意に低かった.1972年以降の原発性膀胱腫瘍男性例を対象として, 職業性および自然発生群の間で比較した.組織学的な腫瘍悪性度に差はみられなかったが, 発病年齢に有意差が認められ, 職業性群は約10年の若齢であった.また職業性群では, 初回治療として膀胱全摘除術が施行された頻度は自然発生群に比して低く, 生存率も有意に高く認められ, 検診による腫瘍の早期発見が効を奏したと考えられた

According to the records of Wakayama Labor Standard Office, at least 1, 085 workers had been exposed to benzidine or beta-naphthylamine in the dyestuff factories in Wakayama City. By October 1988, 101 of them (9.3%) were confirmed to have urinary tract tumors. Including 2 other cases exposed in Osaka, a total of 103 cases of occupational uroepithelial cancer were studied here clinically. Site of tumors was bladder in 91 cases, renal pelvis in 2, ureter in 5 and papillomatosis type in 5. The age at the time of diagnosis ranged from 25 to 87 years with a mean of 53.8 years. The average latent period was 22.7 years, but the older the age of the worker at the start of exposure, the shorter was the latent period. In Wakayama, the proper system of healthy examination for chemical workers using urinary cytology was begun in 1970. Since then, more tumor cases have been discovered in comparison to the patients admitted with subjective symptoms of hematuria. The effectiveness of this group examination was significant in the incidence of total cystectomy in surgical treatment and in survival rate. In the comparative study between the groups of patients with occupational and spontaneous bladder cancer, the average age at diagnosis in the former was about ten years younger. Although the histological grade of tumor was not different between the two groups, the incidence of total cystectomy was lower and the survival rate was significantly higher in the occupational group.