原発性腎孟腫瘍の臨床的検討

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1)最近13年間に経験した16例の原発性腎盂腫瘍の平均年齢は63.9歳で,男性は女性の4.3倍で,患側に左右差は認められなかった.2)主訴は肉眼的血尿が13例ともっとも多く,ついで側腹部痛の2例であった.3) IVP所見としては,陰影欠損が68.7%ともっとも多かった.ついで無造影腎が25%で,造影群に比し予後不良であった.4)尿細胞診では,自然尿では46.1%,RP時におけるカテーテル尿では50.0%の陽性率であった.5)手術法としては,腎尿管摘出術兼膀胱部分切除術が9例ともっとも多く施行された.6)病理組織学的には全例が移行上皮癌で,stageとgradeがよく相関し,いずれも予後を決定する重要な因子であった.7)膀胱腫瘍併発の1例において術前と術後に1回ずつ経尿道膀胱腫瘍切除術を施行した.8)原発性腎盂腫瘍16例の1年生存率は86%,3年生存率78%,5年生存率68%であった.9) Low stage群とhigh stage群,low grade群とhigh grade群はp<0.05で生存率に有意差が認められたSixteen cases of primary renal pelvic tumor treated at our Department between July, 1971 and June, 1984, were reviewed. The sixth decade predominated over other age groups and occupied 47.3% of all cases (average: 63.9 years). The sex ratio was 4.3:1 with male patients predominating over female patients. The incidence of the affected side was equal; 8 cases in the right and 8 cases in the left renal pelvis. The most common initial symptom was macroscopic hematuria in 13 cases (81.2%), followed by flank pain in 2 cases (12.5%). The major findings in IVP were filling defect in 11 cases (68.7%) and non-visualizing kidney in 4 cases (25.0%). Positive urinary cytology was obtained in 6 cases (49.1%) by voided urine specimen and 4 cases (50.0%) by catheterized urine specimen. Histologically, all cases were transitional cell carcinoma; 11 of them were low stage and 5 were high stage at the initial diagnosis. Nine patients(56.1%) were treated by total nephroureterectomy associated with partial cystectomy. The over all survival rate at 1,2,3,4 and 5 years was 86%, 78%, 78%, 68% and 68%, respectively, by the Kaplan-Meier method. The five year survival rate was 80% for the low stage group and 0% for the high stage group. (p less than 0.05, generalized Wilcoxon test). The five year survival rate was 83% for the low grade group and 40% for the high grade group. (p less than 0.05, Generalized Wilcoxon test) Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.

原発性腎孟腫瘍の臨床的検討

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