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目的提高输尿管癌的诊治水平。方法回顾性总结1990年1月至2005年3月收治的24例原发性输尿管癌患者的临床资料。男19例,女5例。年龄38～72岁,平均年龄59岁。左侧16例,右侧8例。肉眼血尿17例(71%),镜下血尿7例(29%)。尿细胞学检查16例,阳性1例。B超提示肾盂积水19例(79%),提示中下段输尿管低回声占位3例(12%)。IVU提示肾盂积水20例(83%),患侧输尿管充盈缺损3例(12%)。逆行肾盂造影检查21例,插管不成功5例,输尿管充盈缺损16例(76%)。CT检查20例,提示输尿管内软组织肿块14例(70%)。螺旋C T薄层扫描3例均确诊。MRU3例,确诊1例。结果24例均进行手术治疗,18例行肾、输尿管全长加膀胱袖状或膀胱部分切除,6例行肾切除加输尿管部分切除。术后病理报告移行细胞癌23例,腺癌1例。1990-1999年的14例中存活1、2、3、4、5、6年者分别为1、5、3、2、2、1例。2000-2005年的10例中,失访3例,术后存活1、3年者各2例,3例存活未满5年者仍在随访中。结论IVU、逆行肾盂造影检查仍是原发性输尿管癌最常用的基本诊断方法,联合其他影像学检查可减少漏诊。本组病例由于手术时病理分期偏晚,5年生存率较低。
Objective To improve the diagnosis and treatment of ureteral cancer. Methods The clinical data of 24 patients with primary ureteral carcinoma admitted from January 1990 to March 2005 were retrospectively reviewed. 19 males and 5 females. Age 38 to 72 years old, average age 59 years old. Left in 16 cases, right in 8 cases. Gross hematuria in 17 cases (71%), microscopic hematuria in 7 cases (29%). Urine cytology in 16 cases, 1 case of positive. B ultrasound prompt hydronephrosis in 19 cases (79%), prompted the middle and lower ureter hypoechoates in 3 cases (12%). IVU prompt hydronephrosis in 20 cases (83%), ipsilateral ureteral filling defect in 3 cases (12%). Retrograde pyelography in 21 cases, intubation in 5 cases, ureteral filling defect in 16 cases (76%). Twenty patients underwent CT examination, which showed that soft tissue mass in the ureter was 14 (70%). Three cases of spiral C T scan were confirmed. MRU 3 cases, diagnosed in 1 case. Results All the 24 cases were operated on. 18 cases of kidney, ureter length and bladder sleeve or bladder partial resection, 6 cases of partial nephrectomy and ureteral resection. Postoperative pathology 23 cases of transitional cell carcinoma, adenocarcinoma in 1 case. In 1990-1999 14 cases of survival 1,2,3,4,5,6 years were 1,5,3,2,2,1 cases. Among the 10 cases from 2000 to 2005, 3 cases were lost to follow-up, 2 cases survived 1 and 3 years after operation, and 3 cases survived within 5 years were still under follow-up. Conclusions IVU and retrograde pyelography are still the most common basic diagnostic methods for primary ureteral cancer. Combined with other imaging studies, the diagnosis of missed diagnosis can be reduced. This group of patients due to surgical staging late, 5-year survival rate lower.