输尿管部分切除术治疗尿路上皮癌复发的影响因素

目的：探讨输尿管部分切除术治疗尿路上皮癌术后复发的危险因素。方法：回顾性分析52例因输尿管尿路上皮癌行输尿管部分切除术患者的临床资料，采用KaplairMeier法、Log-rank检验及Cox模型对临床资料进行统计分析，并对肿瘤是否复发进行随访。结果：尿找瘤细胞阳性（P=0.036）及病理高级别（P=0.011）是肿瘤复发的危险因素。对浸润型肿瘤（pT2、pT3）及并发脉管瘤栓者，术后行局部放疗不能降低复发风险（P=0.660）。对具有复发危险因素者，术后行膀胱灌注能降低复发风险（P=0.037）。对于肿瘤位于输尿管远端需行输尿管膀胱再植者，术中打开膀胱与未打开膀胱相比，术后复发率差异无统计学意义（P=0.565）。结论：临床应提高对术前尿找瘤细胞检查的重视程度，因为它既是明确上尿路肿瘤诊断的常用方法，也是判断预后的重要依据。对具有病理高级别及尿找瘤细胞阳性等复发危险因素者，术后应行膀胱灌注治疗。

Affecting Factors of the Recurrence after Partial Ureterectomy for Urothelial Cancer

Objective：To determine the risk factors of the reeurrence after partial ureterectomy for urothelial cancer. Methods：The clinical datas of 52 patients underwent partial ureterectomy for ureteral urothelial cancer were retrospectively analyzed with KaplairMeier method, Log-rank test and Cox regression. Results： Positive result of urine cytology（P=0.036） and high grade tumors （P=0.011） are risk factors for recurrence. External radiotherapy can not lower the recurrence rate of patients with infiltrated tumor （pT2 ,pT3） or vessel tumor embolus（P=0. 660）. Postoperative intravesical therapy can decrease the recurrence rate of patients with risk factors （P=0.037）. No statistical difference in recurrence rate were found between ureteral reimplantation with opening bladder and without opening bladder for patients with distal ureteral tumors （P= 0. 565）. Conclusions：We should pay more attention for the urine cytology because it is not only the routine method for dignosis of upper ureteral tract tumors, but also prognostic factor for surgical treatment. Postoperative intravesical therapy should be used in patients with risk factors such as positive result of urine cytology and high grade tumors.