腎尿路悪性腫瘍で死亡した患者の終末期の検討

Analysis of patients in the terminal phase of the urogenital malignancy

　2004年4月～2006年12月までに死亡した腎尿路悪性腫瘍患者19名を対象に，臨床的検討を行った。診断時年齢は尿路上皮癌，前立腺癌ではやや高齢であり，病悩期間，疼痛苦悩期間は前立腺癌患者で長い傾向にあった。全体的に病悩期間の9割は自宅療養可能であったが，介護困難などを理由に長期入院のうえ最期を迎える患者も少なくなかった。最終入院の契機は疼痛やADL低下であったが，外来で鎮痛薬を使用していたものが6名と少なく，反省すべき点であった。患者，家族へのサポート体制が整えばさらに良い終末期医療を提供できると思われ，またQOLを低下させる疼痛に対して積極的に鎮痛薬を使用すべきであると思われた。

In the past 3 years, 19 patients in our hospital died due to urogenital malignancy. The average age of the patients diagnosed with urothelial cancer, prostate cancer, and renal cancer was 77, 80, and 68 years, respectively. Due to bone metastasis, the patients with prostate cancer suffered from carcinomatous pain for a longer period than those with renal or urothelial cancer（532, 125, and 78 days, respectively）. However in our hospital, analgesic agents were started to be administered at a very late stage. We should start administering agents, including opiate analgesics at an earlier stage. Although most of the patients were treated at home for an adequate amount of time, several didn't receive good care at home and died at our hospital after prolonged hospitalization. Although palliative cares unit and teams have been established, they are inadequate at present. Therefore, to support the treatment of home a patients, our hospital must cooporate with visiting nurses and health care workers.