保留肾脏手术治疗原发性输尿管癌27例分析

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。

Analysis of 27 kidney-sparing surgeries in the treatment of primary ureteral cancer

Objective：To discuss the diagnosis,feasibility and prognosis of kidney-sparing surgery in the treatment of primary ureteral urothelial carcinoma.Method：A retrospective study of 27 cases undergoing kidney-sparing surgery for primary ureteral urothelial carcinoma was carried out.There were 21 males and six females with the mean age of 63 years.All were single-focal tumor including 17 cases on the left side and 10 cases on the right side.Tumors located at lower segments of the ureter in 19 cases and the middle and upper tracts in eight cases.The maximal diameter of tumors was 0.6-1.8cm.The course of disease was 7-40 days.Fourteen cases had gross hematuria and three patients had microscopic hematuria.Two cases had flank pain and eight patients had been revealed hydronephrosis accidentally by B-ultrasonic scan.B-ultrasound indicated space-occupying lesion of the ureter in nine cases,and IVU showed filling defect of the ureter in 17 patients.Retrograde pyeloureterography demonstrated filling defect of the ureter in eight cases,and CT indicated ureteral mass in 16 cases,of which three cases were found local ureteral wall infiltration.Ureteroscopic examinations and biopsies were performed in 12 cases.Five patients were found malignant cells by urine cytology examination.Fifteen cases were treated surgically of segmental ureterectomy,and the other 12 patients underwent distal ureterectomy and bladder cuff excision.Result：Pathological findings showed that 19 cases were lower stage（Ta-T2）and grade（G1-G2）ureteral cancer,six cases were T3G2,two cases were T1G3 ureteral cancer.Twenty-five cases had been followed up for six months to nine years（mean,43months）.The tumor-specific survival was 84%（21/25）and the overall survival was 72%（18/25）.Sixteen cases had been followed up for more than five years,of which nine cases underwent distal ureterectomy and bladder cuff excision and the other seven patients underwent segmental ureterectomy,12 cases were tumor-free survivors.Conclusion：B-ultrasound is the f