膀胱腫瘍に対する水圧療法の評価

Abstract

Thirty cases of bladder carcinoma which have been treated thirty-two times by Helmstein's hydrostatic pressure technique are presented. Double condom method for saline infusion was used under epidural anesthesia. Optimal intravesical pressure was adjusted at patient's diastolic pressure plus 25 cm H2O, and this state was continued for maximum five hours. The results were as follows: 1) Complete necrosis was obtained 12 times, partial necrosis 11 times and poor effect 9 times. 2) Total effective ratio was 76.7%. Treatment given 4 to 5 hours duration showed 100% effective ratio. 3) Effective ratio related to the localization of the tumor was 67% in dome, 62% in posterior wall, 60% in lateral wall, 50% in anterior wall and 46% in vicinity of ureteral orifice or trigone. 4) Renal functional damage related to this treatment was minimaL Serum creatinine and BUN was within normal limit before, during and after treatment. As posttreatment renal insufficiency was reported, patients should be observed attentively. 5) After hydrostatic pressure treatment, additional treatments were given 111 the fourth week. Endoscopic surgery was easily done in the complete and partial necrosis group. 6) Before and 4 weeks after treatment, histologic examination was done. In the complete necrosis group, lymphocyte, plasma cell and eosinophile infiltration were seen before treatment and markedly increased after treatment. Although no lymphocytic infiltration was shown before in partial necrosis group, lymphocyte infiltration was increased in posttreatment specimens. 7) Simultaneously, lymphocyte count, T-cell, B-cell, and immunogloblin G, A, M in peripheral blood were determined. These values remained unchanged before and after treatment. 8) PHA, Con A-induced lymphocyte blastogenesis showed an interesting fact. No reccurrence group showed high responses, which were elevated after treatment. Half of the recurrence group showed low responses, which were unchanged or decreased after treatment. These observations indicate that some immunological processes were included m hydrostatic pressure treatment.