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62歳女.主訴は右側腹部痛であった.CTにて右腎腫瘍を指摘され入院となった.精査によるCTで, 右腎結石, 右腎実質の菲薄化と右腎盂内に腫瘍性病変を認め手術となった.腰部斜切開したところ, 右腎と十二指腸の癒着が強く, 腎臓を摘出すると, 腎盂と十二指腸との瘻孔を認めた.又, 尿管も下大静脈壁と強く癒着していた為, 尿管摘除術は断念し, 瘻孔部の十二指腸を腹部正中切開にて部分切除し, 手術を終了した.病理では, 腫瘍は乳頭状腺癌で周囲への浸潤は認められなかった.瘻孔部及び十二指腸側への浸潤も認められず, 瘻孔の原因は急性及び慢性の腎盂腎炎による炎症と考えられた.術後7日目に創部感染を合併した為, 再縫合術を施行し, 7日後に退院となった.現在, 厳重に経過観察中である, A 62-year-old woman visited our hospital complaining of fever and right flank pain. On excretory pyelography the right kidney containing three renal stones was not visualized. Retrograde pyelography revealed an irregular filling defect in the right renal pelvis. Computed tomography revealed renal stones and a tumor mass in the right renal pelvis. From these findings, the pelvic tumor of the right kidney complicated by renal stones was diagnosed. Right nephrectomy was performed. Because a fistula between the renal pelvis and the second portion of the duodenum was found in the operation, partial resection of the duodenum was also performed. Pathological diagnosis was adenocarcinoma of the renal pelvis and pyeloduodenal fistula due to chronic pyelonephritis. Postoperative chemotherapy was not given. This is the first case report of adinocarcinoma of the renal pelvis coexisting with a pyeloduodenal fistula.

他臓器の合併症を初めとしてなんらかの理由で手術施行が不可能であった進行性膀胱癌15例, 膀胱全摘除術試行後の骨盤内再発10例に対しSeldinger法に準じて皮下埋没型リザーバーシステムを設置し動注化学療法を施行.局所再燃前立腺癌23例, 内分泌療法不応性局所進行型前立腺癌5例に対してリザーバーを動注化学療法を施行.使用薬剤は, methotrexate, cis-platinum, adriamycinを用いた動注化学療法を入院で施行, 外来通院中で可能な症例には5-FUもしくはcarboplatinを維持化学療法として施行.膀胱癌で平均6回, 前立腺癌で平均4回施行.局所が制癌されている期間には, 遠隔部位での増悪は認めなかった.膀胱癌でPR18例NC7例, 前立腺癌でPR11例, NC14例.奏効期間は, 膀胱癌で最大46ヵ月, 中央値23ヵ月, 前立腺癌で最大32ヵ月, 中央値12ヵ月.副作用は, 全身化学療法に比較して軽度であった, A clinical study was performed on the efficacy of intra-arterial chemotherapy using a reservoir system for advanced urological malignancies. The reservoir system was indwelted in the femoral subcutaneous layer by Seldinger's method. Fifteen cases of inoperable complicated advanced bladder cancer and 10 cases of postoperative local recurrent bladder cancer were administered intra-arterial chemotherapy using a reservoir system. Then, 23 cases of local relapsed prostate cancer and two cases of endpocrine-resistant prostate cancer were administered the chemotherapy. The administered anti-cancerous agents were methotraxate, cis-platinum and adriamycin, then 5-FU or carboplatin was administered as maintenance therapy. The mean number of courses of chemotherapy was six for bladder cancer and four for prostate cancer. During stabilization of the local lesion, no distant deterioration was recognized. The overall clinical efficacy was a positive response (PR) and no change (NC): for 18 and 7 cases of bladder cancer, and 11 and 14 cases of prostate cancer, respectively. The median duration of stabilization was 23 months for bladder cancer and 12 months for prostate cancer. The adverse effects were fever than those with systemic chemotherapy.