進行癌による上部尿路閉塞症例に対する尿管ステント留置の意義

Clinical relevance of ureteral stent indwelling for the patients with ureteral obstruction due to advanced cancer

　1997年から2007年までに，進行癌による上部尿路閉塞に対し尿管ステント留置を試みた72例を対象とし，成功率，留置後の有害事象について検討した。ステント留置からの生存期間は中央値7か月で，全例癌死であった。留置成功率は76.4％（55例）であった。婦人科癌，膀胱鏡での異常所見，高度水腎症のいずれかを認める場合には，有意に成功率が低かった。有症状群ではステント留置により85.2％で症状改善を認めた。有害事象は17例（30.9％）に認め，その大部分が3か月以内に発生した。有症状群では症状改善が期待でき，ステント留置を積極的に行う意味はあると考える。無症状群では有害事象によりQOL低下をきたすこともあり，原疾患の予後などを十分に考慮し，ステント留置の適応を検討すべきである。

　We investigated the clinical relevance of indwelling ureteral stent for patients with advanced cancer. Indwelling ureteral stents were tried for malignant ureteral obstruction in 72 patients from 1997 to 2007 and the success rate as well as adverse events after the treatment were investigated retrospectively. Median overall survival of patients after ureteral indwelling was 7 months,and all patients finally died due to progression of the cancer. The success rate of indwelling ureteral stents was 76.4％（55 of 72 patients）. The success rate was significantly lower in patients with gynecological cancer,abnormal findings on cystoscopy,or severe hydronephrosis. Adverse events occurred in 17 patients（30.9％）The adverse events mainly occurred within 3 months after indwelling of the ureteral stent. In the symptomatic patient group,85.2％ had improvement of their symptoms. An indwelling ureteral stent effectively relieved symptoms of ureteral obstruction due to advanced malignancy. In the asymptomatic patient group,the indication for stent indwelling should be deliberately considered based on the prognosis of the patient,purpose of cancer management,and adverse events.