腎孟尿管腫瘍33例の臨床的検討

Abstract

11年間に経験した33例について検討を行った.1)発症は33歳から77歳, 平均年齢65.7歳, 男性27例, 女性6例であった.2)主訴は血尿が最も多く, 受診までの期間は1ヵ月以内が約70%を占めた.3) IVP所見としては, 腎盂腫瘍では陰影欠損, 尿管腫瘍では無機能腎が最も多かった.尿細胞診は, 陽性率55%であった.4)全例に手術を施行し, 術式は腎尿管全摘出術・膀胱部分切除術が最も多かった.術後補助療法として, 放射線療法10例, 化学療法6例に施行した.5)病理組織学的には, 移行上皮癌が97%であり, 腫瘍のgradeとstageには関連が認められた.6)術後の膀胱腫瘍の発生は10例で, low grade, low stage群にもみられた.7) Kaplan-Meier法によると3年生存率68%, 5年生存率62%であり, high grade, high stage群, IVPで無機能腎を呈したものの予後が不良であった

Thirty-three cases of primary renal pelvic and/or ureteral tumors, i.e., 14 renal pelvic tumors, 14 ureteral tumors and 5 renal pelvic and ureteral tumors, treated at our hospital between November, 1976 and August, 1987 are reviewed retrospectively. Tumor occurred on the right side in 18 cases, left side in 14 cases and bilateral in one case. The patients ranged in age from 33 to 77 years (average 65.7 years), the sex ratio was 4.5:1 with male predominance over female. The most frequent symptoms were gross hematuria in 22 cases (67%). Interval from onset of initial symptoms to first visit within one month for 23 cases (70%). The major findings of excretory urograms were non-visualizing kidney in 18 cases (55%) and filling defect in 12 cases (36%). Positive urinary cytology was obtained in 18 cases (55%). Operative therapy was performed in all cases, namely, total nephroureterectomy with partial cystectomy in 21 cases (64%) and nephrectomy with transurethral ureterectomy in 7 cases (21%). Histopathologically, all cases but one case of squamous cell carcinoma were transitional cell carcinoma. Subsequent bladder tumors were found in 10 cases (30%). The overall survival rate at 1, 3 and 5 years were 84%, 68% and 61%, respectively by Kaplan-Meier method. In this series, grade and stage of tumor were the most influential factors for prognosis.