尿膜管腫瘍9例の治療経験

Abstract

症例は1989年までの12年間に治療を受けた男性7例・女性2例〔37～54(平均47)歳〕であった.術前診断にCT・MRIは有用であり, CEAは3例に上昇していたことからも腫瘍の残存・再発モニターとなり得る.stage 3Aに対し臍・尿膜管全摘+膀胱部分切除及び補助療法による膀胱機能保存手術でも根治性は得られると思われた

Recently, we encountered 9 cases of urachal tumor and conducted clinical studies on its diagnosis and treatment. The chief complaint was gross hematuria in all cases. Computed tomographic scan was performed in 7 cases, and in all cases it revealed a tumor between the dome of the bladder and the Retzius' cavity. This finding strongly suggested a urachal tumor before pathological study. Magnetic imaging resonance (MIR) was performed in one of the 9 cases, and it indicated the extent of the tumor more clearly than computed tomography. Partial cystectomy + en bloc removal of the umbilicus and urachus was performed in 5 cases, radical cystectomy + en bloc removal of the umbilicus and urachus was performed in 2 cases, and radical cystectomy was performed in 2 cases. As postoperative therapy, radiotherapy was administered to 4 cases, and chemotherapy was administered to 4 cases. One case died from cancer after 4 years and 10 months, while the other 8 cases are being treated on an outpatient basis without any local recurrence. All 5 patients who underwent partial cystectomy are alive (mean survival time: 97 months). Thus we believe that cure can be achieved by partial cystectomy and adjuvant therapy. In addition, serum carcinoembryonic antigen is thought to be useful as an indicator of residual tumor or local recurrence.