腎孟尿管腫瘍の臨床的観察

Abstract

過去21年間に経験した原発性腎盂尿管腫瘍54例につき集計, 検討した.1)54例の平均年齢は63.4歳であり, 男女比は2.4:1であった.患側は右21, 左33と左に多かった.2)主訴は血尿が87%と最も多く, ついで疼痛が11%であった.症状初発から1ヵ月以内に受診したのは約1/3であった.3)腫瘍の部位は, 腎盂腫瘍24例, 尿管腫瘍25例, 腎盂尿管腫瘍5例であった.4) IVP所見では, filling defect 23例とnon-visualized kidney 22例が多かった.5)組織学的には移行上皮癌53例, 乳頭腫1例であった.6)併発膀胱腫瘍は, 先行性に6例, 同時性に10例, 続発性に5例認めた.7)治療の主体は手術であり一側尿路全摘除兼膀胱部分切除術が21例と最も多く, ついで一側尿路全摘除術と単純腎摘術がそれぞれ11例であった.8)腎盂尿管腫瘍の5年生存率は53%であった.悪性度と浸潤度は予後によく相関した.手術法については, 一側尿路全摘除術に膀胱部分切除術を加えたものは加えないものとの間に予後に差はなかった.先行性, 続発性の膀胱腫瘍の合併は予後を悪化させないが, 同時性の膀胱腫瘍は予後を著しく悪化させた

We report 54 patients with urothelial tumors in upper urinary tract admitted to our hospital between July, 1962 and December, 1985. The patients consisted of 38 males and 16 females; side their ages ranged from 47 to 88 years with a mean of 63.4 years. The affected side was the right side in 21 cases, and the left side in 33 cases. Macro-or microhematuria was observed in 87% of the patients. Pathologically, 53 of the patients had transitional cell carcinoma and 1 had papilloma. Six patients had a past history of bladder tumor. Simultaneous bladder tumor was identified in 10 cases. Vesical recurrence was observed in 5 cases. Total nephroureterectomy with bladder cuff resection was employed as the surgical method in 21 cases, and total nephrectomy without bladder cuff resection in 11 patients. The actual five-year survival rate was 53% for all the patients; 52% for patients with renal pelvic tumors, 75% for those with ureteral tumors and 15% for those with renal pelvic and ureteral tumors. The patients who received nephroureterectomy had a postoperative survival rate similar to that of those who received nephroureterectomy with bladder cuff resection. A simultaneous bladder tumor lowered the survival rate.