原发性输尿管恶性肿瘤28例早期诊治分析

目的提高原发性输尿管恶性肿瘤的早期诊治水平。方法总结13年间收治的28例原发性输尿管恶性肿瘤患者。男∶女为18∶10,平均年龄61岁。左侧20例,右侧5例,双侧2例,单侧多中心1例。肉眼血尿占64.3%,镜下血尿占35.7%。超声提示肾盂积水23例、输尿管低回声占位15例。IVU提示肾盂积水16例、输尿管充盈缺损6例。成功逆行肾盂造影检查26例,输尿管充盈缺损23例。螺旋CT扫描阳性率为78.6%（22/28）。IVU显示不清8例患者MRU检查均显示患侧肾积水并见充盈缺损。结果28例均行手术治疗,11例行肿瘤局部输尿管切除术,8例行肾切除加输尿管部分切除,5例行输尿管下段切除膀胱移植术,4例行肾、输尿管全长加膀胱袖状或膀胱部分切除。术后病理报告移行细胞癌26例,腺癌1例,鳞癌1例。前7年的13例中,失访2例,存活2,3,5,6,8年者分别为1,3,4,1,2例,〉5年生存率为63.6%。后6年的15例中,失访1例,术后存活1,3,5,7,10年者分别为2,3,5,3,1例,〉5年生存率为64.2%。结论超声是发现肾积水的敏感方法,尤其在体检中能早期发现,肾积水成为早期诊断输尿管肿瘤的重要线索。IVU、螺旋CT是追查肾积水的基本检查,逆行肾盂造影是诊断输尿管癌不可缺少的有创深入检查,MRU可弥补IVU和逆行肾盂造影检查的缺陷。本组患者由于发现较早,肿瘤分期分级低,5年生存率较高。

EARLY DIAGNOSIS AND TREATMENT OF PRIMARY URETERAL CANCER:A REPORT OF 28 CASES

Objective To improve the level of early diagnosis and treatment of primary tumor of ureter.Methods The clinical data of 28 patients with primary ureteral cancer during 13 years were retrospectively analyzed.The subjects include 18 male and 10 female,the median age of whom was 61 years old.The tumors were situated in the left ureter（20 cases）,in the right ureter（5 cases）in the bilateral ureters（2 cases）and unilateral multiple ureteral cancer（1 case）.Gross hematuria presented in 64.3% cases and microscopic hematuria presented in 35.7% cases. Doppler ultrasonography showed hydronephrosis in 23 cases, ureter hypoechogenie masses in 15 cases. IVU showed hydronephrosis in 16 eases, ureteral filling defect in 6 cases. Retrograde pyelograpgy was successfully performed in 26 cases and showed ureteral filling defect in 23 cases. CT scan showed ureter soft masses in 22 cases （78.6%）. MRU showed hydronephrosis and ureteral filling defect in 8 cases whose IVU results were not so good. Results All of 28 patients were treated with surgery. 11 patients were treated by partial ureterectomy, 8 patients by nephrectomy and partial ureterectomy, 5 patients by partial lower ureterectomy and ureteroneocystostomy, 4 patients by nephrectomy, ureterectomy and partial eystectomy. The postoperation pathology reports showed 26 cases were transitional cell carcinoma, 1 ease was adeno-carcinoma and 1 ease was squamous carcinoma. There were 13 cases in the period of 1993 to 2000, the survival cases in 2, 3, 5, 6 and 8 years after surgery were 1, 3, 4, 1, 2, including 2 lost cases. The five- year survival rate was 63. 6 %. There were 15 cases in the period of 2001 to 2007, the survival cases in 1, 3, 5, 7 and 10 years after surgery were 2, 3, 5, 3 and 1. The five- year survival rate was 64.2 %. Conclusion Doppler ultrasonography is a convenient method for diagnosing hydronephrosis, especially in the early stage of diseases. Hydronephrosis is an important sign implying ureteral tumors. IVU and spiral CT are primary tools to fu