原発性尿管腫瘍の臨床的検討

Abstract

1)最近13年5ヵ月間に経験した原発性尿管腫瘍22例の平均年齢は63.6歳で, 男性は女性の3.4倍であった.2)主訴は肉眼的血尿が17例ともっとも多く, ついで顕微鏡的血尿の2例であった.3)患側は左側15例と多く, 発生部位としては下部尿管が14例であった.4)尿細胞診では, 自然尿の場合17例中5例, 逆行性腎盂造影時におけるカテーテル尿で9例中3例, 両者を併用した場合は19例中9例がclass 4以上を示した.5) IVP所見では, 無造影腎11例, 陰影欠損7例, 水腎症2例の順であった.6)病理組織学的には, 移行上皮癌19例, 扁平上皮癌1例, 粘膜下脂肪腫1例, ポリープ1例であった.7)膀胱腫瘍の併発が, 術前に4例, 術後に3例認められた.8)手術としては, 腎尿管摘出術兼膀胱部分切除術が16例ともっとも多かった.9)尿管原発性悪性腫瘍20例の1年生存率は84%, 3年生存率55%, 5年生存率35%であった.10)予後を判定する因子としては, grade, およびstageが重要であり, high gradeもしくはhigh stageの症例では, いずれも予後不良の症例が多かった.またIVP所見にて無造影腎は予後が不良であった

Twenty-two cases of primary ureteral tumors treated at our Department between July 1971 and December 1984, were reviewed. The patients ranged from 28 to 83 years old (average 63.6 years). There were 17 males and 5 females (3.4:1). The affected side was predominantly the left (15) than the right (7). The most common site of the tumor growth was at the lower third of the ureter (14 cases, 63.6%). The most common initial symptom was macroscopic hematuria, which was seen in 17 cases (77.3%). The major finding of IVP was non-visualizing kidney in 11 cases (50.0%) and filling defect in 7 cases (31.8%). Positive urinary cytology was obtained in 9 cases (52.9%) by voided urine and 6 cases (66.6%) by catheterized urine. Total nephroureterectomy associated with partial cystectomy was performed in 14 cases (63.6%). Histologically, 19 cases were transitional cell carcinoma (86.8%). Associated growth of urothelial tumor in the bladder was found in 4 cases preoperatively and in 3 cases during the course of postoperative follow up. All of them were treated by transurethral resection. Overall survival rate at 1, 2, 3, 4 and 5 years was 84, 71, 55, 46 and 35%, respectively, by the Kaplan-Meier method. The five year survival rate was 54% for the low stage group and 0% for the high stage group; 54% for the low grade group and 26% for the high grade group. (p value = not significant, generalized Wilcoxon test).