上部尿路上皮性腫瘍の臨床的観察 第1編 : 原発性腎盂腫瘍

Abstract

1963～1981年までの19年間に当科で加療した原発性腎盂腫瘍は40例あり, 男性30例:女性10例, 平均60.5歳であった.臨床症状は血尿が圧倒的に多く, 初発症状から受診までの期間は多くは6ヵ月未満であった.1VPでは無機能腎と陰影欠損が同程度存在し, 尿細胞診の陽性率は46.7%と高率で, 本疾患の診断方法として重要である.手術は32例に行ない, うち20例に完全腎尿管摘除術を施行した.病理組織では, 29例が移行上皮癌, 4例が結石を伴なった扁平上皮癌であった.腫瘍のgradeとstageには相関関係が示唆された.併発尿路上皮性腫瘍は40例中尿管に3例, 膀胱に7例, 尿道に1例でうち重複発生を2例に認めた.術後尿路上皮性腫瘍の発生を残存尿管に1例, 膀胱に7例見た.予後は5年実測生存率で75.9%で, 予後に影響する因子では腫瘍のgradeとstageが最も重要であり, 術後補助療法に関しては現在のところ有効なものは認められなかった

Forty primary renal pelvic tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 30 males and 10 females (3: 1), and average age was 60.5 years old. The major symptoms were hematuria and flank pain; however, palpable mass was rare. The majority of patients were admitted to our clinic within 6 months from manifestation of symptoms. The major findings of IVP were non-functioning kidney and filling defect. The positive rate of urinary cytology was 46.7%. Total nephroureterectomy with bladder cuff was performed in 20 out of 32 cases. Histologically, 29 cases were transitional cell carcinoma and 4 cases were squamous cell carcinoma with renal calculi. Simultaneous urothelial tumors were seen in 10 cases, 3 in the ureter and 7 in the bladder. A subsequent ureteral tumor was found in one out of 12 cases in which ureters were resected incompletely, and 7 subsequent bladder tumors were found out of 32 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by the actuarial method was 75.9%. Among several factors, grade and stage of the tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.