原発性腎盂腫瘍の臨床的観察

Abstract

1974年から10年間に原発性腎盂腫瘍(PPT)18例を経験し, 同期間の外来患者数, 入院患者中のPPAの割合はそれぞれ0.15%, 1.05%であった.性別は男11例, 女4例, 左側9例, 右側6例, 平均年齢は58.3%であった.主訴は肉眼的血尿12例, 側腹部痛1例, 全身倦怠感2例で, IVPでは無機能腎8例, 陰影欠損2例, 水腎2例, 腎杯変形3例であった.尿細胞疹陽性は8例であった.手術は腎尿管全摘出術兼膀胱部分切除術7例, 腎尿管摘出術1例, 腎摘出術7例で, 術後の補助療法は化学療法5例, 放射線療法2例に行った.術後尿路上皮腫瘍の発生は残存尿管兼膀胱1例, 膀胱のみは7例にみ, 全例2年以内に発生した.病理組織学的には, 移行上皮癌14例, 扁平上皮癌1例であった.Grade別では0は無く, 1が1例, 2 5例, 3 9例で, stage別では0が1例, A 2例, B 0例, C 7例, D 5例であった.実測生存率は3年67%, 5年48%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 renal pelvic tumors treated at our Hospital between 1974 and 1983, were reviewed retrospectively. The patients ranged in age from 41 to 74 years old (average: 58.3 years old). There were 11 males and 4 females, the ratio being 2.8:1.0. The affected side was left in 9 cases and right in 6 cases. 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 8 cases (53.3%). Positive urinary cytology was obtained in 8 cases (53.3%). As the surgical method, total nephroureterectomy with bladder cuff was performed in 8 cases, nephroureterectomy in one case and nephrectomy in 6 cases. Histologically, 14 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumors were seen in the bladder of 2 patients. A subsequent ureteral tumor was found in one of the 7 cases in which ureters were resected incompletely, and subsequent bladder tumors were found in 8 of the 15 cases receiving surgical treatment in the follow-up period. All of tumors were found within 2 years after operation. Over-all actual survival rates at 1, 3 and 5 years were 87%, 67%, 48%, respectively. Three and 5 year actual survival rates were 100%, 100% respectively for the low stage group and 59%, 29% respectively for the high stage group. Three and 5 year actual survival rates were 100%, 78%, respectively for the low grade group and 44%, 27% respectively for the high grade group. Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.