当教室における過去10年間(1969.4-1979.3)の原発性尿管癌の治療成績

Abstract

Clinical studies of 23 patients with primary ureteral carcinomas who visited our department in 10 years from April 1969 to March 1979 have been made. The patients ranged in age from 55 to 77 years old with a mean of 63.5 years. The most common presenting complaint was macroscopic or microscopic hematuria (83%). Laboratory studies revealed anemia in 2 cases, increased sedimentation rate in 14 cases, positivity of CRP in 5 cases, elevated serum α2-globulin in 11 cases, and elevated plasma fibrinogen in 2 cases. The cytologic study of the voided or ureteral urine was carried out in 17 cases and positive results were obtained in 10 cases (58.8%). Tumors protruding beyond the ureteral orifice were seen in 10 of the 23 cases. Absence of excretion of contrast medium from the kidney was seen in 12 of 22 cases who underwent excretory urography. One of the 12 cases survived more than 5 years. Retrograde pyelography was carried out in 16 cases. An irregular filling defect or goblet deformity of ureterogram was seen in 15 cases. Nineteen cases underwent total nephroureterectomy, and 4 of the 19 cases subsequently developed bladder tumors and the risk was increased when the lower ureter was involved. The over-all 5-year survival rate was 56.8 per cent and was primarily influenced by the invasiveness and degree of histopathological malignancy of the tumor. In the cases with stage 0, A and B1 5-year survival rate was 80 per cent and in the cases with stage B2 and C, 1-year survival rate was 33.3 per cent. In the low grade malignancy tumors and high grade malignancy tumors, 5-year survival rate was 90 and 40 per cent, respectively. Clinical importance of the prophylactic use of intravesical instillation of anticancer drugs was emphasized.