上部尿路上皮性腫瘍の臨床的観察-2-原発性尿管腫瘍
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1963年から1981年までの過去19年間に当科で治療した原発性尿管腫瘍は計25例あり,男性18例,女性7例,平均年齢は63.0歳であった.臨床症状は血尿が圧倒的に多く,症状初発から受診までの期間は多数例が6ヵ月未満に受診していた.1VP所見は過半数で無機能腎を示した.尿細胞診は19例中12例(63.2%)と高率に陽性を示し,尿管腫瘍の診断方法として重要である.手術は23例に施行し,うち21例に完全腎尿管全摘除術を施行した.病理組織は22例が移行上皮癌.1例が扁平上皮癌であった.移行上皮癌についてgradeとstageとの間には相関関係の存在が示唆された.他の尿路上皮性腫瘍の合併は,膀胱腫瘍が13例認められ,術後尿路上皮性腫瘍の発生は膀胱に3例,尿道に1例であった.予後は5年実測生存率で39.4%であり,予後に影響を及ぼす因子は腫瘍のgradeとstageが最も重要で,術後補助療法はしない方が結果は良好であったTwenty-five primary ureteral tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 18 males and 7 females (2.6: 1), and average age was 63.04 years old. The major symptom was hematuria. The majority of the patients were admitted to our clinic within 6 months from manifestation of symptoms. The major finding of IVP was non-functioning kidney. The positive rate of urinary cytology was 63.2%. Total nephroureterectomy with bladder cuff was performed in 21 out of 23 cases. Histologically, 22 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumor was found in 13 cases in the bladder. Most of the ureteral tumors (63.6%) were found in the lower third segment of the ureter. Subsequent urothelial tumors were seen in 3 bladders and one urethra out of 22 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by actuarial method was 39.4%. Among several factors, grade and stage of tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.
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