原発性腎盂癌の臨床的観察

Abstract

過去10年間の原発性じん盂がん16例につき臨床的に観察した.1) 70歳代に多く平均年齢63.8歳, 男女比2.2:1, 患側は右側6例, 左側10例であった.2)主訴は肉眼的血尿15例, 側腹部痛3例で, 症状発現より来院までの期間は約半数が1ヵ月以内であった.3)遠隔転移のない14例を手術した.内訳はじん尿管全摘出術11件, 単純じん摘出術2件とじん部分切除術1件であった.4)病理組織型は全例移行上皮がんで, 膀胱がん取扱い規約によるgradeは, G1 5例, G2 6例とG3 3例で, Cumming's分類によるstageは1 2例, 2 4例, 3 7例と4 3例であった.5)予後は, 生存9例(NED 4例, 膀胱再発5例), 死亡7例(がん死6例)で, Kaplan-Meier法による5年累積生存率34.1%と不良であった.6)血沈値と予後, stage間に有意差をみた.7)自験例のじん盂がんの診断に寄与した各検査項目は, RP(逆行性腎盂造影), US(超音波検査法), 尿細胞診, CT (Computed tomography), 血管造影, DIU(排泄性尿路造影)の順で, USとCTに有用性をみた

Sixteen patients with transitional cell carcinoma of the renal pelvis seen at our Hospital between December 1973 and February 1984 were reviewed and the diagnostic tools were evaluated. The patients (11 males, 5 females) ranged in age from 35 to 81 years (mean 63.8). Ten tumors were found on the left side and 6 on the right side. The most frequent symptom was macrohematuria (93.8%). Total nephroureterectomy including the cuff was performed in 11 cases, simple nephrectomy in 2 cases and partial nephrectomy in one case. Lymphadenectomy was performed in 4 cases. According to the general rules for clinical and pathological studies on bladder cancer in Japan, 5 cases were classified grade 1, 6 cases as grade 2 and 3 cases as grade 3. According to Cummings' staging, 2 cases were in stage 1, 4 in stage II, 7 in stage III and 3 in stage IV. The cumulative survival rate at 5 years was 34.1% by Kaplan-Meier's method. The diagnostic tool contributing to the confirmation of the renal pelvic cancer was the retrograde pyelogram in 12 out of 15 patients (80.0%).