原発性尿管腫瘍の臨床的観察

Abstract

1974年より10年間に原発性尿管腫瘍15例を経験した.その間の外来新患者数は10, 230名, 入院患者数1433名であった.男11例, 女4例, 60歳代が最も多く, 平均65.5歳である.左5例, 右10例, 発生部位上部2例, 下部13例であった.主訴は肉眼的血尿12例, 腹部腫瘍, 側腹部痛, 体重減少各1例であった.IVPでは無機能腎11例, 陰影欠損3例, 水腎1例で, 尿細胞診陽性9例であった.手術的療法は腎尿管摘出術兼膀胱部切除術10例, 腎尿管摘出術兼膀胱全摘出術2例, 試験開腹術のみ3例であった.術後の補助療法は化学療法のみ3例, 放射線療法は4例であった.他の尿路上皮腫瘍の併発は膀胱に4例みた.病理組織学的には全例移行上皮癌であった.grade別では0はなく, 12例, 27例, 36例, stage別では, 01例, A5例, B1例, Cはなく, D8例であった.実測生存率は1年59%, 3年と5年ともに42%であった.予後に影響する因子としては, gradeとstageが最も重要である

The 15 cases of the primary ureteral tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The incidence of primary ureteral tumors among the outpatients in our urologic clinic was 0.15%. The patients ranged in age from 50 to 75 years old (average: 65.5 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The right ureter and the lower third of the ureter were involved more frequently than other areas. The most frequent symptom was macrohematuria which was seen in 12 cases (80%). The major finding of IVP was non-functioning kidney, which was seen in 11 cases (73.3). Positive urinary cytology was obtained in 9 cases (60%). Twelve patients underwent nephroureterectomy with bladder cuff or total cystectomy. Histologically, all cases were transitional cell carcinoma. Simultaneous urothelial tumors were seen in the bladder in 4 cases (26.7%). The over-all actual survival rates at 1, 3 and 5 years were 59%, 42%, 42%, respectively. The 5-year actual survival rate was 63% for the low grade group and 0% for the high grade group. The 5-year actual survival rate was 82% for the low stage group and 0% for the high stage group. Among several factors, grade and stage of the tumor were the most influencing factors for prognosis.