根治的膀胱全摘除術が施行された高齢患者についての臨床的検討

Clinical study of radical cystectomy in elderly patients with bladder cancer

　膀胱全摘除術は高侵襲のため，高齢者では積極的に選択されない傾向がある。当科で膀胱全摘除術を施行した46例のうち，手術時75歳以上であった10例について検討した。内訳は男性8例，女性2例で，平均年齢は79.1歳であった。尿路変向は，自排尿型代用膀胱が3例，導尿型代用膀胱が6例，尿管皮膚瘻が1例であった。平均手術時間は382分，平均出血量は2,767mlであった。観察期間中に3例が死亡した。若年症例と比較すると，手術時間は有意に短かったが（p＝0.02），出血量は有意差を認めず（p＝0.55），5年生存率でも有意差はなかった（p＝0.65）。全身状態が良好な高齢症例では，膀胱全摘除術を積極的に検討するべきと示唆された。

　We compared the clinical results of radical cystectomy on 10 elderly patients over 75 years old to those on 36 younger patients to determine whether age was one of the critical points for the application of radical cystectomy. Between April 1995 and April 2006, bladder substitution was performed after cystectomy using the Hautmann, Studer, or Mainz procedure in 9 of the elderly patients. Urinary diversion was performed after cystectomy using ureterocutaneostomy procedure in 1 of them. Neither prolongation of the operation time, nor increase in amount of bleeding was observed in bladder substitutions used for elderly patients in comparison with younger patients. The rate of complications in the elderly patients was not different from those in the younger patients. The cause-specific survival rate and overall survival rate of the elderly patients were similar to those of the younger patients. In conclusion, indication of radical cystectomy and selection of urinary reconstruction procedure are not dependent on patient's age, orthotopic urinary reservoir and continent urinary reservoir were found to be useful for even an elderly patient.（Rinsho Hinyokika 61：243-247, 2007）