子宮頸癌患者の膀胱の変化に就いて
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The changes occurring in the urinary tract as a cancerous new growth develops in the cervix uteri are many and varied; and some of them are signs which cannot be made light of. The author performed cystoscopy, indigocarmine test for renal functions, and urinary sediment and smear tests in 346 cases of cancer of the cervix uteri selected at random from among those treated at this department from June, 1954 to May, 1957, for the purpose of evaluating these methods of test from the clinical standpoint. The results of the investigation are summarized as follows: 1. The changes in the bladder increase in severity with the advance of the stage of cancerous growth in the cervix uteri; and worsening in morbid changes in the bladder occurs simultaneously with the infiltration of the new growth into the broad ligament. 2. The rate of excretion of the dye through a ureter of that part of parametrium to which the cancer has infiltrated decreases, as the stage of cancer advances. With the spread of cancer in the cervix uteri, its influence on the upper urinary tract increases. 3. Edema found by cystoscopy is one of the important factors to be taken into consideration in deciding whether a patient is operable or not. It may well be expected that the presence of the edema of a high degree makes it nearly impossible, to separate the uterus from the bladder. Separating the uterus from the bladder was impossible in 19 of 217 cases (8.7 %) clinically found operable, which had been predicted as a result of cystoscopy before the operation. 4. As a result of irradiation treatment, edema in the bladder shows improvement to a certain extent degree in some cases, shows exacerbation in others, and occurs afresh in still others. 5. No evidence of complications of a serious nature resulting from irradiation was found in cases which had received irradiation of radium following total hysterectomy. 6. Of the advanced cases of cancer of the cervix uteri which were found inoperable and which received irradiation treatment, those cases where the uterine arteries had been ligated presented better picture of the bladder half a year to one year after the irradiation than those where the uterine arteries had not been ligated. The same was true of the finding in the cervix uteri of those two groups of patients. 7. The prognosis of those cases of cancer where edema of a high degree in the bladder does not respond to irradiation treatment is generally poor. Improvement in the cancerous tissue was proved in 75 % of the cases which showed improvement of conditions in the bladder.
- 千葉大学の論文
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