原发性输尿管癌的诊断与治疗(附21例报告)

目的加强对原发性输尿管癌的认识,提高对原发性输尿管癌的诊断及治疗水平。方法回顾性分析21例输尿管癌患者的临床资料,比较术前彩超、泌尿系CT成像(CTurography,CTU)和输尿管镜检等诊断符合率情况,讨论术前检查方法的差异。所有患者均行手术治疗,术后常规行膀胱灌注治疗,评估治疗后情况,总结原发性输尿管癌的诊断及治疗经验。结果所有患者的术后病检结果均为输尿管癌。比较术前彩超、CTU和输尿管镜检等检查结果表明,CTU和输尿管镜检诊断符合率明显高于彩超,差异具有统计学意义(P<0.05),CTU和输尿管镜检对输尿管癌的诊断符合率均较高,两者间差异无统计学意义(P>0.05)。A、B期输尿管癌患者尽早手术,术后获得较好的预后。结论对于输尿管肿瘤患者,应联合进行CTU和输尿管镜检查,早发现、早治疗,尽可能采取肾、输尿管全长及膀胱袖状切除术,条件许可时,可采用组合腔镜技术。术后规律随访并膀胱灌注腔内化疗,有利于预防输尿管癌术后膀胱癌复发,改善输尿管癌的预后。

Diagnosis and treatment of primary ureteral cancer (report of 21 cases)

Objective To strengthen the theory about primary ureteral carcinoma and elevate diagnosis and treatment of primary ureteral cancer.Methods We reviewed data of 21 patients of primary ureteral cancer,and campared the result of color ultrasonography,CTU,ureteroscopy and pathological diagnosis and evaluated various kinds of diagnostic means.All patients accepted operations(either open or laparoscopic radical nephroureterectomy) and bladder intracavitary chemotherapy post operation.We summarized the diagnostic and therapeutic experience.Results The diagnosis was confirmed by pathology.Campared with color ultrasonography,CTU and ureteroscopy were much more accurate(P<0.05).There was no difference between CTU and ureteroscopy(P>0.05).Patients treated with radical nephroureterectomy got a better outcome especially as they were early stage(stage A and/or stage B).Conclusions We should take more attention to the patients who maybe suffer from the primary ureteral tumor.Examination(CTU and/or ureteroscopy) should be performed.Treatment should be done as diagnosis confirmed.Radical nephroureterectomy is the first choice for patients.Postoperative follow-up and bladder intracavitary chemotherapy regularly are the key points to improve the tumor-free survival time of patients.