膀胱腫瘍に対する膀胱保存的手術の進歩と問題

概要

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1957年以降,1985年6月までの膀胱腫瘍症例761例につき,施行された膀胱部分切除術およびTURの適応と治療成績につき検討した.良好な成績が得られる部分切除の適応例はTURにても充分コントロールが可能なpT2以下,gradeではG1および一部のG2であると考えられ,さらに浸潤した腫瘍に対しては積極的に膀胱全摘に進むべきであるRetrospective analysis of the bladder tumor patients was performed to reveal the clinical results of partial cystectomy or transurethral resection (TUR). The observed 3-, 5-, 10-year survival rates after 143 partial cystectomies indicated for the first tumors were 66.2%, 57.1% and 41.5% respectively. To obtain satisfactory results, however, the operation should be indicated for pT2 or G0-G1. Some of the G2 tumors could also be the candidates for this procedure, but the stage of the disease must be below T2. At present, all these tumors could be well controlled by TUR, and this statement was confirmed by the study of clinical results obtained by TUR. The analysis also revealed a poor outcome in 6% of the low grade or low stage tumors and it increased to 25% in high grade and pT2. The complete cure of the high stage or high grade tumor is still difficult, but to improve the survival rate, radical surgery should be employed more positively instead of partial cystectomy. The reasons for this conclusion are also discussed.