腎盂尿管腫瘍の臨床的検討

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1974～1983間の該当入院治療症例は,腎盂腫瘍15例,尿管腫瘍21例,腎盂尿管重複例3例の計39例であり,総外来新患者数の0.15%であった.男25女14例.平均年齢は65.2歳であった.初発症状,主訴ともに血尿が多く,発症から来院まで1ヶ月未満の症例は28.6%であった.Urogram上では,IVP, RPとも陰影欠損が重要で,その頻度ももっとも多かった.尿細胞診は1例平均2.6回施行し,陽性率は33.4%であった.病理組織学的には,腎盂腫瘍15例中,移行上皮癌14例,乳頭腫1例,尿管腫瘍21例中,移行上皮癌19例,ポリープ1例,転移性腺1例であった.膀胱にも腫瘍の認められたものは,腎盂腫瘍で2例,尿管腫瘍で1例,腎盂尿管重複例では2例であった.手術は36例に施行し,26例に腎尿管摘除兼膀胱部分切除を施行した.膀胱再発は7例,18.9%に認められた.5年生存率は腎盂腫瘍37.4%,尿管腫瘍40.7%であった.なお腎盂尿管重複例で予後不良であったことを特記したThe 39 cases of renal pelvic and ureteral tumors treated in our hospital from 1974 to 1983, were reviewed retrospectively. The 39 cases included 15 renal pelvic tumors, 21 ureter tumors and 3 ureteropelvic tumors. The incidence of these tumors was 0.15% among all new outpatients. Sex distribution was 25 males to 14 females, and mean age was 65.2 years old. Hematuria was the most frequent initial symptom and chief complaint. Of the patients, 28.6% had come to our hospital within one month after their initial symptoms appeared. "Filling defect", an important finding of IVP and RP, was revealed most frequently. The positive rate of urine cytology was 33.4%. Histological examination revealed 14 transitional cell carcinoma and 1 papilloma of 15 renal pelvic tumors and 19 transitional cell carcinoma, 1 polyp and 1 metastatic adenocarcinoma of 21 ureter tumors. Operative therapy was performed on 36 patients; 26 by nephroureterectomy with partial cystectomy. Vesical recurrence rate was 18.9%. The 5-year survival rate was 37.4% on renal pelvic tumor and 40.7% on ureter tumor. The factors, high grade, high stage, and ureteropelvic double tumor, which reflect the specificity of the malignant potential, also affected prognosis. In conclusion, post-operative adjuvant therapy was thought to be valuable in the near future.

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由井康雄
日本医科大学泌尿器科

腎盂尿管腫瘍の臨床的検討

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