输尿管癌术后再发尿路上皮癌  

Recurrent urothelial cancer after resection of ureteral carcinoma

作　　者：孔垂泽[1,2] 慈健[1,2] 刘同才[1,2] 张铭铮 张维国[1,2] 杨涛 李书章 李芳[1,2] 孙志熙[1,2] 李泽良 

机构地区：[1]中国医科大学第一临床学院泌尿外科 [2]沈阳市第五人民医院泌尿外科

出　　处：《中华肿瘤杂志》1998年第6期465-467,共3页Chinese Journal of Oncology

摘　　要：目的为防治输尿管癌术后再发尿路上皮癌，对其再发因素及特点进行探讨。方法采用回顾性研究对３５例输尿管癌进行随访总结。结果肾输尿管膀胱部分切除的３２例中，再发膀胱癌１６例，占５０．０％。同时发生尿路上皮多器官癌１４例，再发膀胱癌１０例，占７１．４％；输尿管单处癌１８例，再发膀胱癌６例，占３３．３％，其中５例为输尿管下段癌术后再发。细胞分级：Ｇ１级４例，无一例再发；Ｇ２～Ｇ３级２８例，再发膀胱癌１６例，占５７．１％。分期：Ｔ１期６例，２年内再发膀胱癌１例；Ｔ２～Ｔ３期２６例，２年内再发膀胱癌１０例，２年后再发５例均为Ⅰ～Ⅱ期。３例肿瘤局部切除术后再发上尿路癌２例。再发时间为术后３个月～６．５年（平均１．８６年）。１６例术后再发尿路上皮癌生存超过３年者３例，８例非再发尿路上皮癌生存超过３年者６例。结论输尿管下段癌同时发生尿路上皮多器官癌和肿瘤细胞分化不良、分期高的浸润性肿瘤术后膀胱癌再发率高，术后应定期做膀胱镜检查。再发尿路上皮癌生存率低，预后不良。Objective To prevent and treat recurrent urothelial cancer after resection of ureteral carcinoma, recurrence associated factors and their features were analyzed. Methods Thirty five cases of ureteral cancer were studied retrospectively. Results There were 16 cases of recurrent bladder cancer among 32 cases after kidney ureter and partial bladder removal. Bladder cancer recurred in 10 of 14 cases (71.4%) with multi organ urothelial cancers. Six out of 18 cases with single ureteral cancer had recurrent cancer in the bladder. In 5 of the 6 cases, the primary tumor was located at the lower ureter. None of the 4 cases in grade Ⅰ had tumor recurrence while there were 16 cases of recurrent bladder cancer in 28 cases in grade Ⅱ Ⅲ. There was one recurrent bladder cancer in 6 cases in stage T 1 within 2 years after operation. Among 26 cases in stage T 2 T 3, 10 cases of recurrent bladder cancer occurred in 2 years. After 2 years, 5 recurrent cases were in stage T 1 T 2. There were 2 recurrent urothelial carcinomas in 3 cases whose tumors were removed by local resection. The time of recurrence was 3 months to 6.5 years (average 1.86 years). Of 16 cases with recurrent urothelial cancer, 3 were alive for more than 3 years after operation. Of 8 cases without recurrence 6 survived for more than 3 years. Conclusion Recurrent urothelial cancer after resection of ureteral cancer occurs more frequently when the neoplasm is located in the lower ureter, involving more than one organ, with high grade cell differentiation and high invasiveness. Prognosis of recurrent urothelial cancer is poor. Regular cystoscopic check up is helpful to find the recurrence.

关 键 词：输尿管肿瘤 尿路上皮瘤 膀胱肿瘤 手术后复发 

分 类 号：R737.13[医药卫生—肿瘤]