同时性尿路上皮多器官肿瘤

目的探讨同时性尿路上皮多器官肿瘤的临床特点，提高诊治效果。方法对获随访的65例同时发生于多个尿路器官的尿路上皮肿瘤进行回顾性总结。男39例，女26例。年龄45～79岁，平均66岁。肾盂癌合并输尿管癌21例，输尿管癌合并膀胱癌17例，肾盂癌合并膀胱癌14例，同时合并肾盂输尿管膀胱癌13例。T1 6例，T2 35例，T3 22例，T4 2例。G1 5例，G2 32例，G3 28例。随访6个月～14年。结果术前诊断同时存在尿路上皮多器官肿瘤59例（90．8％）。术前诊断准确率B超32．3％（21／65），IVU 45．3％（29／64），逆行肾盂造影56．8％（25／44），CT 81．5％（53／65），螺旋CT尿路三维重建91．7％（11／12），CT三维重建联合膀胱镜检查100．0％（12／12）。术后再发膀胱癌46例（70．8％），2年内再发36例。G1、G2、G3术后膀胱癌再发率分别为20．0％、81．3％和67．9％，G1与G2～G3两组比较差异有统计学意义（P＜0．05）。T1、T2、T3术后膀胱癌再发率分别为66．7％、80．0％和63．6％；T4 2例均于术后短期内死亡，无膀胱癌再发。术后即时膀胱灌注化疗术后膀胱癌再发率63．2％（12／19），未灌注化疗者73．9％（34／46）。3年生存率41．7％，5年生存率30，6％。结论螺旋CT三维成像加膀胱镜检查是发现同时性尿路上皮多器官肿瘤的良好方法。同时性尿路上皮多器官肿瘤术后容易再发膀胱癌，肿瘤细胞分化不良者术后膀胱癌的再发率高。术后密切观察，建议除定期膀胱镜检查外，尚需行尿路造影检查。

Urothelial tumors that synchronize in multiple organs

Objective To investigate the clinical featu res, diagnosis and treatment of urothelial tumors that synchronize in multiple o rgans. Methods A total of 65 patients (39 men and 26 wom en;age range,45-79 years;mean age,66 years) with synchronous multiple urothelial tumors who had undergone follow-up were reviewed. Of them,21 cases had carcino mas of renal pelvis and ureter;17 cases had carcinomas of ureter and bladder;14 cases had carcinomas of renal pelvis and bladder;13 cases had concurrent carcino mas of renal pelvis,ureter and bladder.By tumor staging,6 cases had stage T_1 t umor;35 cases,T_2;22 cases,T_3;and 2 cases,T_4.By tumor grading,5 cases had G _1 tumor;32 cases,G_2; and 28 cases,G_3.Follow-up ranged from 6 months to 14 years. Results Among the 65 patients, 59 (90.8%) were p reoperatively diagnosed with urothelial tumors in multiple organs.The preoperati ve accuracy rate was 32.3%(21/65) by B-ultrasound,45.3%(29/64) by IVU,56.8%(25/ 44) by retrograde pyelography,81.5%(53/65) by CT,91.7%(11/12) by spiral CT urina ry tract three-dimensional reconstruction, and 100.0%(12/12) by CT three-dimen sional reconstruction plus cystoscopy,respectively. After operation 46 patients (70.8%) had bladder carcinoma recurrence; and 36 of them had recurrence within 2 years.The recurrence rates of G_1,G_2 and G_3 bladder carcinoma were 20.0%, 81.3% and 67.9%,respectively.The recurrence rate of G_2-G_3 cases was signific antly higher than that of G_1 cases (P<0.05).The postoperative recurrence r ates of T_1,T_2 and T_3 bladder carcinoma were 66.7%,80.0% and 63.6%,respecti vely.Two cases of T_4 carcinoma died shortly after operation. The recurrence ra te of patients who received single immediate post-operative instillation of che motherapy agent was 63.2%(12/19), and that of those without instillation was 7 3.9%(34/46).The 3-,5-year survival rates were 41.3% and 30.5%,respectively. Conclusions Three-dimensional spiral CT in combination with cystoscopy is a good means for detection of synchronous multiple urothelia l tumors.Bladder tumor recurrence is more common in synchronous multiple urothel ial tumors and it is correlated with tumor grade.Close follow-up, including reg ular cystoscopy and urography,is required.