膀胱腫瘍の臨床統計学的観察 - 15年間の治療成績を中心として -

Abstract

1965年より1979年までの15年間に当科で扱った原発性膀胱腫瘍226名を対象として臨床統計的観察を行なった.男女比は4:1, 年齢は23～92歳, 平均60.4歳であり, 初発症状は血尿が79.2%と最も多く, 頻尿, 排尿痛がこれに続いた.腫瘍発生部位は側壁が最も多く47.3%で, 後壁, 全壁, 三角部の順に多かった.治療を受けた184例の組織像は移行上皮乳頭腫10.4%, 移行上皮癌81.0%, 腺癌2.7%, 扁平上皮癌2.2%であった.初回手術療法は経尿道手術89例, 腫瘍単純摘除術16例, 膀胱部分切除術37例, 膀胱全摘除術20例であり, 保存的治療法としては抗癌剤の膀胱内注入療法14例, 温熱療法1例, 放射線療法5例が行なわれた.各手術療法別の5年実測生存率はTUR群79.1%, TVR群59.4%などで, 膀胱保存手術, 膀胱全摘除群とも低悪性度腫瘍の方が予後良好であった.膀胱保存手術施行の142例中38例, 26.8%に再発がみられた

Between 1965 and 1979, 226 newly diagnosed cases of bladder tumor were seen at our hospital. A follow-up study was made on 184 adequatedly treated patients. The male to female ratio was 4.0. Age distribution showed a peak incidence in the 70s. Chief complaints were hematuria (79.2%), urinary frequency (7.1%), burning upon urination (2.2%), urinary retention (2.2%), and flank pain (0.9%). Location of the tumor was the lateral wall in 47.3% of the cases, the postesior wall in 25.2%, the trigone in 5.8%, the vesical neck in 5.8%, the anterior wall in 3.1%, and the dome in 2.2%. Histologically, 81% were transitional call carcinoma, 2.7% were adenocarcinoma, 2.2% were squamous cell carcinoma and 10.4% were transitional cell papilloma. The 5-year survival rate (observed survival rate) in each initial treatment group was: 79.1% for TUR; 59.4% for TVR; 68.2% for partial cystectomy; and 35.9% for simple total cystectomy. Local recurrence in the groups of conservative surgery occurred in 26.8% of the cases. For the group of partial cystectomy, the recurrence rate was higher in patients with a high grade tumor than those with a low grade tumor.