原発性尿管癌24例の臨床的観察

Abstract

1972年1月から10年間の原発性尿管癌24例の臨床的観察をおこなった.1)尿管癌が泌尿器科外来新患患者の0.17%を占めた.2) 41～84歳, 平均年齢は65歳であった.3)男:女は3:1であった.4)左側に多く, 下部尿管1/3に多かった.5)臨床症状は, 肉眼的血尿が19例ともっとも多く, ついで, 腰痛6例であった.6)尿細胞診は, 18例9例が陽性であった.7)膀胱鏡検査では, 腫瘍の尿管口からの突出を4例に認め, ついで尿管口部の隆起を2例に認めた.8)排泄性腎盂造影では, 24例中10例に陰影欠損を認め, 逆行性腎盂造影では10例全例に陰影欠損を認めた.9) CTは9例中4例に腫瘍部に一致しmassを認めた.10)腎尿管全摘除兼膀胱部分切除術あるいは膀胱全摘除術を14例に施行した.11)5年生存率は56.5%で, 予後は, 浸潤度, 悪性度と密接に関係した

A clinical survey was performed on 24 cases of primary ureteral tumors treated in our University Hospital between Jan. 1972 and Dec. 1981. The incidence of primary ureteral tumors was 0.17% among the outpatients in our urologic clinic. The patients ranged from 41 to 84 years old in age (average age: 65 years), and the male to female ratio was 3 to 1. The left ureter and the lower third of the ureter were involved more frequently. The most frequent initial symptom was macrohematuria seen in 19 cases (79%), followed by loin pain seen in 6 cases (25%). A cytologic study of the voided urine or ureteral urine was carried out in 18 cases and positive results were obtained in 9 cases (50%). Cystoscopic examination revealed a tumor protruding through the ureteral orifice in 16.7% (4 of 24 cases), followed by bulging orifice in 8.3% (2 of 24 cases). Excretory pyelography showed ureteral filling defects in 41.7% (10 of 24 cases). Retrograde pyelography showed ureteral filling defects in 100% (10 of 10 cases). CT showed a mass region in 44.4% (4 of 9 cases). A total of 14 patients underwent nephroureterectomy with partial or total cystectomy (66.7%). The overall 5-year-survival rate was 56.5% and could be directly associated with grade and stage of tumors.