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目的:探讨输尿管部分切除术治疗尿路上皮癌术后复发的危险因素。方法:回顾性分析52例因输尿管尿路上皮癌行输尿管部分切除术患者的临床资料,采用KaplaiMeier法、Log-rank检验及Cox模型对临床资料进行统计分析,并对肿瘤是否复发进行随访。结果:尿找瘤细胞阳性(P=0.036)及病理高级别(P=0.011)是肿瘤复发的危险因素。对浸润型肿瘤(pT_2、pT_3)及并发脉管瘤栓者,术后行局部放疗不能降低复发风险(P=0.660)。对具有复发危险因素者,术后行膀胱灌注能降低复发风险(P=0.037)。对于肿瘤位于输尿管远端需行输尿管膀胱再植者,术中打开膀胱与未打开膀胱相比,术后复发率差异无统计学意义(P=0.565)。结论:临床应提高对术前尿找瘤细胞检查的重视程度,因为它既是明确上尿路肿瘤诊断的常用方法,也是判断预后的重要依据。对具有病理高级别及尿找瘤细胞阳性等复发危险因素者,术后应行膀胱灌注治疗。
Objective: To investigate the risk factors for the recurrence of urothelial carcinoma after partial ureterrectomy. Methods: The clinical data of 52 cases with ureteropelvic partial ureteral carcinoma underwent resection were retrospectively analyzed. The clinical data were analyzed by KaplaiMeier method, Log-rank test and Cox model. The recurrence of the tumor was followed up. Results: The finding of positive urine tumor cells (P = 0.036) and high pathological grade (P = 0.011) were the risk factors of tumor recurrence. For infiltrating tumors (pT_2, pT_3) and patients with concurrent vascular tumor suppository, postoperative local radiotherapy failed to reduce the risk of relapse (P = 0.660). Postoperative bladder irrigation reduced the risk of relapse (p = 0.037) for those at risk of recurrence. There was no significant difference in postoperative recurrence rate between open bladder and non-open bladder for tumor located in the distal ureter with ureteral bladder replantation (P = 0.565). Conclusion: It is necessary to improve the preoperative examination of urinary tumor cells for attention, because it is not only a clear method of diagnosis of upper urinary tract tumors, but also an important basis for judging the prognosis. On the high-level pathology and urinary tumor-positive cells and other recurrence risk factors, postoperative bladder irrigation should be treated.