子宮頸がん患者における根治的子宮摘出術後の腎機能と神経原性膀胱の長期評価

Long-term evaluation of renal function and neurogenic bladder following radical hysterectomy in patients with uterine cervical cancer.

• Hiroaki Komatsu
• Tetsuro Oishi
• Daiken Osaku
• Akiko Kudoh
• Ruri Shimogai
• Jun Chikumi
• Shinya Sato
• Tasuku Harada

抄録

目的:

本研究の目的は、根治的子宮摘出術が腎機能に影響を与えるかどうかを明らかにすることであった。

OBJECTIVE: This study aimed to determine whether radical hysterectomy (RH) affects renal function.

方法:

2006年から2015年の間にRHを受けたIB1-IIB期の子宮頸がん患者83人を対象に、腎機能の追跡調査を行った。血清クレアチニン（sCre）値は術前と術後1年ごとに測定した。推定糸球体濾過率（eGFR）はsCre値を用いて算出した。自力で排尿できない患者や残尿量が100mL以上の患者は、神経原性膀胱（NB）と診断され泌尿器科を紹介された。神経因性膀胱の発生とsCreレベルまたはeGFRの変化との関係をそれぞれ評価した。

METHODS: Renal function was followed up in 83 patients with stage IB1-IIB cervical cancer who underwent RH during 2006-2015. Serum creatinine (sCre) levels were measured preoperatively and every year postoperatively. Estimated glomerular filtration rate (eGFR) was calculated using sCre levels. Patients who were unable to urinate by themselves or whose residual urine was ≥100 mL were referred to a urologist with the diagnosis of neurogenic bladder (NB). The relationship between NB occurrence and changes in sCre level or eGFR was evaluated respectively.

結果:

45例（54.2％）で泌尿器科的介入が必要となり、41例（49.3％）で自己尿道カテーテル検査が行われた。NB群とクリーン間欠カテーテル検査（CIC）群では、非NB群や非CIC群では観察されなかったsCreレベルの有意な上昇を示した。非NB群では、eGFRは手術後に変化しなかった。しかし、NB群では、術後2年後、3年後、最終フォローアップ時にeGFRの有意な低下が認められた。心血管イベントの発生率にはNB群と非NB群で差はなかった。

RESULTS: Urological intervention was required in 45 patients (54.2%), and self-urethral catheterization was performed in 41 (49.3%) patients. The NB and clean intermittent catheterization (CIC) groups exhibited significant increases in sCre levels, which were not observed in the non-NB or non-CIC groups. In the non-NB group, eGFR did not change following surgery. However, in the NB group, significant decreases in eGFRs were observed at postoperative 2 and 3 years and at final follow-up. There was no difference in the incidence of cardiovascular events between patients with and without NB.

結論:

根治的子宮摘出術後のNB患者では、術後2年後に有意な腎機能の低下が認められた。

CONCLUSION: In patients with NB following RH, a significant decrease in renal function was observed after postoperative 2 years.

© 2020 Japan Society of Obstetrics and Gynecology.