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目的:探讨上尿路上皮肿瘤的临床特征及诊疗经验。方法:回顾性分析我院2002年6月～2007年6月收治的57例上尿路上皮肿瘤患者的临床资料:肾盂肿瘤20例,输尿管肿瘤35例,病变累及肾盂输尿管2例。首发症状为肉眼血尿53例,体检发现4例;术前13例行尿脱落细胞学检查(13/57,22.81%)确诊,33例行B超检查(33/57,57.89%)确诊,28例行IVP检查(28/45,62.22%)确诊,41例行CT检查(41/45,91.11%)确诊,50例行MRU检查(50/52,96.15%)确诊,9例行输尿管镜检查(9/9,100%)确诊。50例行标准根治术,7例行输尿管部分切除术。结果:术后52例获得随访,随访率91.23%。1年和5年肿瘤特异性生存率分别为92.31%(48/52)和59.62%(31/52),其中肾盂肿瘤1年和5年特异性生存率为94.74%(18/19)和68.42%(13/19);输尿管肿瘤1年和5年特异性生存率为93.55%(29/31)和51.61%(16/31);2例病变累及肾盂输尿管者,1例术后4个月肿瘤转移死亡,另1例随访6年未见肿瘤复发和转移。本组死亡患者肿瘤分级/分期多为G2～G3/T2～T3者。结论:肿瘤的分级和分期是预测上尿路上皮肿瘤预后的重要因素;术前行CT、MRU及输尿管镜检查对早期明确诊断有帮助,经积极治疗可提高患者生存率。
Objective: To investigate the clinical features and diagnosis and treatment of upper urothelial tumors. Methods: The clinical data of 57 cases of upper urinary tract epithelial tumors admitted from June 2002 to June 2007 in our hospital were analyzed retrospectively: 20 cases of renal pelvis tumor, 35 cases of ureteral tumor and 2 cases of ureteropelvic ureter. The first symptom was gross hematuria in 53 cases and physical examination in 4 cases. Thirteen patients were diagnosed as exfoliative cytology (13/57, 22.81%) before operation, 33 (57/57, 57.9%) were diagnosed by B ultrasound, The routine IVP examination (28/45, 62.22%) was confirmed, 41 cases were confirmed by CT (41/45, 91.11%), 50 cases were confirmed by MRU (50/52, 96.15%) and 9 cases by ureteroscopy (9 / 9,100%) confirmed. 50 cases of standard radical mastectomy, 7 cases of partial ureter resection. Results: 52 cases were followed up, the follow-up rate was 91.23%. The 1-year and 5-year tumor-specific survival rates were 92.31% (48/52) and 59.62% (31/52), respectively. The 1-year and 5-year specific survival rates of renal pelvis tumors were 94.74% (18/19) and 68.42 % (13/19). The 1-year and 5-year specific survival rates of ureteral tumors were 93.55% (29/31) and 51.61% (16/31) respectively. Two cases had ureteropelvic involvement and one case had 4 months Tumor metastasis and death, another case of 6 years of follow-up no tumor recurrence and metastasis. The death of patients in this group were mostly staging / staging G2 ~ G3 / T2 ~ T3. Conclusion: The classification and staging of tumor are important factors in predicting the prognosis of upper urothelial tumors. Preoperative CT, MRU and ureteroscopy are helpful in the early diagnosis. After active treatment, they can improve the survival rate of patients.