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目的:探讨原发性输尿管尿路上皮癌的诊断及其保留肾脏手术治疗的预后。方法:回顾性分析我院1993年3月~2011年10月27例保留肾脏手术治疗原发性输尿管尿路上皮癌患者的临床资料。男21例,女6例;年龄46~81岁,平均63岁;均为输尿管单发肿瘤,左侧17例,右侧10例;肿瘤位于下段输尿管19例,中上段8例;肿瘤最大径0.6~1.8cm。病史7~40d,平均15d。以无痛性肉眼血尿就诊14例,显微镜下血尿3例,腰部胀痛2例,B超偶然发现肾积水8例。9例B超显示输尿管占位病变,17例IVU显示输尿管充盈缺损,8例逆行输尿管造影显示输尿管充盈缺损,16例经薄层CT增强扫描见输尿管内占位性病变,其中3例提示有输尿管壁浸润,12例输尿管镜检查并活检,尿液细胞学检查发现恶性细胞5例。15例行输尿管节段切除(SU),端-端吻合术,12例输尿管末段+膀胱袖状切除(DU+BCE)。结果:19例为低分期(Ta~T2期)、低分级(G1~G2)输尿管癌,6例为T3、G2,2例为T1G3输尿管癌。25例获得随访,随访时间6个月~9年(平均43个月),肿瘤特异性生存率为84%(21/25),总体生存率72%(18/25)。16例随访时间超过5年,其中9例行DU+BCE,7例为节段输尿管切除,无癌生存12例。结论:B超显示肾积水较IVU敏感,是较早的输尿管癌提示性信息。保留肾脏手术治疗原发性输尿管癌创伤小,不仅是一种姑息性手术,也可以作为治疗低分期分级输尿管癌的一种选择。DU+BCE治疗下段输尿管癌可以取得与根治术相似的疗效。
Objective: To investigate the diagnosis of primary ureteral urothelial carcinoma and its prognosis of preserving renal surgery. Methods: A retrospective analysis of our hospital from March 1993 to October 2011 27 cases of patients with preserved renal surgery for primary urinary tract urothelial carcinoma in patients with clinical data. 21 males and 6 females; aged 46 to 81 years old, average 63 years old; all were single ureter tumors, 17 on the left side and 10 on the right side. Tumors were located in the lower ureter in 19 cases and in the upper middle section in 8 cases. 0.6 ~ 1.8cm. A history of 7 ~ 40d, an average of 15d. In painless gross hematuria treatment of 14 cases, 3 cases of hematuria under microscope, 2 cases of lumbar pain, B-supernatural found in 8 cases of hydronephrosis. 9 cases of B-ultrasound showed lesions of the ureter, 17 cases of IVU showed ureteral filling defect, 8 cases of retrograde ureterography showed ureteral filling defect, 16 cases of ureteral lesions by thin-section CT enhanced scan, of which 3 cases prompted the ureter Wall infiltration, 12 cases of ureteroscopy and biopsy, urine cytology found 5 cases of malignant cells. Fifteen patients underwent ureteral segmentectomy (SU), end-to-end anastomosis, and 12 cases of distal ureter + bladder sleeve resection (DU + BCE). Results: 19 cases had low stage (stage T2 ~ stage T2), low stage (G1 ~ G2) ureteral cancer, 6 cases were T3, G2, and 2 cases were T1G3 ureteral carcinoma. Twenty-five patients were followed up for 6 months to 9 years (average 43 months). The tumor-specific survival rate was 84% (21/25). The overall survival rate was 72% (18/25). Sixteen patients were followed up for more than 5 years, including 9 cases of DU + BCE, 7 cases of segmentectomy and 12 cases without cancer. CONCLUSIONS: B-ultrasound is more sensitive to hydronephrosis than IVU and is an early indication of ureteral cancer. Retained renal surgery for primary ureteral cancer trauma, not only is a palliative surgery, but also can be used as an option to treat low-grade ureteral cancer. DU + BCE treatment of lower ureteral cancer and radical surgery can achieve similar efficacy.