膀胱浸潤大腸癌に対する予測残存膀胱容量から見た膀胱拡大術の適応

概要

論文の詳細を見る
膀胱浸潤を伴った大腸癌に対し,浸潤部の膀胱を合併切除することにより良好な予後が期待される.その際の膀胱再建の要否についての明確な選択基準はない.今回,膀胱浸潤大腸癌の予後と術後排尿機能温存に必要な膀胱容量について検討した.2001年から2011年までに膀胱浸潤大腸癌を8例経験した.全例膀胱部分切除を行い,直接縫合を4例,膀胱拡大術を5例(局所再発1例)に行った.膀胱を球体とみなし,膀胱半径から膀胱内腔面積を算出した.この膀胱面積から膀胱切除面積を引き,予測残存膀胱容量を求めた.当科で経験した膀胱浸潤大腸癌9手術例をretrospectiveに考察し,予測残存膀胱容量を数量化し,術後排尿機能温存に必要な膀胱容量について検討した.予測残存膀胱容量は220~413mlで,220mlの症例で排尿障害を認めたが,223mlの症例では直接縫合でも排尿機能が温存できた.予測残存膀胱容量が220ml未満の場合に膀胱拡大術の適応があるのではないかと考えられた.遠隔成績は無再発生存中が8例中5例で,3例に5年生存がえられた.Colorectal cancers often infiltrate the urinary bladder, but combined resection of the main tumor and invaded region may have a good cure rate in such patients. Standard guidelines for selecting the treatment procedure to patients with colorectal cancer that has infiltrated the urinary bladder have not been established. The purpose of this study was to assess the postoperative bladder capacity for preserving the bladder function. We carried out nine operations in 8 patients with colorectal cancer involving the urinary bladder between 2001 and 2011. Direct closure was performed for 4 patients. Augmentation by ileocystoplasty was performed in 5 cases(1;recurrent case).Functional bladder volume is defined as 7ml/ kg, and we assumed the shape of a urinary bladder is a sphere. Expected post-operative bladder capacity was calculated using a formula based on these parameters. We investigated the post-operative urinary function and calculated the post-operative bladder capacity for these 9 cases. The post-operative bladder capacity of each patients ranged from 220ml to 413ml. Although one patient's calculated post-operative bladder capacity was 223ml, the patient had good bladder function. However, another patient whose calculated post-operative bladder capacity was 220 had disturbed function. The patient with a calculated post-operative bladder capacity of less than 220ml may have an operative indication for augmentation by cystoplasty. Postoperative results is 5 patients is surviving without recurrence and 3 patients survived over 5 years.
2013-05-01

膀胱浸潤大腸癌に対する予測残存膀胱容量から見た膀胱拡大術の適応

スポンサーリンク

概要

著者

関連論文

スポンサーリンク