保留肾脏术式治疗原发性输尿管癌临床分析

摘要

目的 探讨保留肾脏术式治疗输尿管癌的临床疗效.方法 回顾性分析了保留肾脏术式治疗原发性输尿管癌的19例患者,其中男性10例,女性9例,平均年龄65.6岁.无痛性肉眼血尿14例,腰痛2例；B超偶然发现肾积水3例.结果 19例患者均行保留肾脏手术.行输尿管部分切除、输尿管端端吻合术的患者4例；输尿管下端及膀胱袖口状切除、输尿管膀胱再植术的患者11例；输尿管镜下切除的患者4例.病理均为移行上皮细胞癌,病理分级:G15例；G28例；G2 ～ G33例；G33例.分期:Ta 1例；T15例；T2 9例；T3 4例.17例病例获得随访(89.5％),5年生存率为58.8％ (10/17).术后6个月～2年膀胱癌发生率29.4％(5/17)；术后1年～6年同侧上尿路癌复发者29.4％ (5/17).3例患者于术后1～3年死于内科疾病.结论 原发输尿管癌为少见的尿路上皮肿瘤,预后不佳.对低分级、低分期的肿瘤保留肾脏术式预后良好,但保肾手术有复发的风险,需密切随访.%Objective To evaluate the clinical treatment and prognosis of the primary transitional cell carcinoma of ureter. Methods Retrospective review of 19 cases who underwent kidney-sparing surgery for treatment of the primary transitional cell carcinoma of ureter was carried out. There were 10 males and 9 females with the mean age of 65. 6 years. 14 cases had gross hematuria and 2 cases had flank pain and in 3 cases renal hydronephrosis was found incidentally by B-ultrasound. Results All cases were treated with kidney-sparing surgery. In 15 cases ureteral segmental resection was performed, in 4 of these cases terminoterminal anastomosis and in 11 cases ureterocystostomy with bladder cuff excision were performed. In 4 cases tumor were resected by ureteroscopy. Postoperative pathological findings confirmed the diagnosis of transitional cell carcinoma. Pathological staging showed Ta (1 cases) , T1 (5 cases) , T2 (9 cases) , T3 (4 cases) and grading showed G, (5 cases) ;G2(8 cases) ; G2-G3 (3 cases) ;G3 (3 cases). Seventeen cases (89. 5% ) were followed up for 3-132 months. The overall 5-year survival rate was 58. 8%. Bladder recurrences occurred in 29. 4% of patients within 6 ~ 24 post-operation months and 29. 4% patient showed ipsilateral upper urinary tract transitional cell carcinoma recurrences within 12 ~ 72 post-operation months. Three cases died of non-tumor illness within 12 ~ 36 months postoperatively. Conclusion The primary transitional cell carcinoma of ureter may be uncommon and has poor prognosis. Kidney-sparing surgery is a feasible treatment option in patients with lower stage and grade. The long-term follow up should be meticulous, because the recurrence rate is high.