肾盂输尿管移行上皮癌术后再发膀胱癌多因素分析  

The postoperative recurrence of bladder cancer in renal pelvis and ureteral transitional cell carcinoma

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

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

出　　处：《中华泌尿外科杂志》1999年第1期20-22,共3页Chinese Journal of Urology

摘　　要：目的防止肾盂输尿管癌术后再发膀胱癌。方法采用回顾性研究对获随访８５例进行总结。结果术后膀胱癌再发率３８％（３２／８５）。吸烟指数＞５００者为５４％（１８／３３），高于不吸烟或吸烟指数＜５００者的２７％（１４／５２），Ｐ＜０．０１。未切除患侧输尿管口周围膀胱壁的再发率为４５％（１０／２２），高于肾输尿管膀胱部分切除术的２０％（９／４５），Ｐ＜０．０５。Ⅱ～Ⅲ级，Ｔ１～Ｔ２，ＣｅｒｂＢ２阳性表达者再发率高，术后灌注化疗２年后再发率５％（２／３９），低于未灌注者的２２％（１０／４６），Ｐ＜０．０５。结论吸烟是术后再发危险因素，切除输尿管口周围部分膀胱壁是防止再发的关键，术后灌注化疗防止远期再发效果好。Objective To investigate the risk factors of the recurrence of postopeative bladder cancer in renal pelvic and ureteral transitional cancer. Methods 85 such cases were retrospectively studied and reviewed. Results The postoperative recurrence of bladder cancer was observed in 38% (32/85).In patients with a smoking index greater than 500 the recurrence rate was 54 (18/33) being significantly higher than the nonsmokers and in those that the smoking index being less than 500 (14/52, P <0.01).If cuff resection of the bladder wall adjacent to the ureteral orifice has not been done during the primary operation the occurence rate of bladder cancer was 45% (10/22) while in those with cuff resection of the bladder wall the recurrence rate was 20% (9/45), P <0.05.The recurrence rate has been high in grade Ⅱ Ⅲ tumors,T 1～T 2 tumors and in C erbB 2 positive cases.If intravesical chemotherapy has been instituted the 2 years recurrence rate of bladder cancer was 5%,being significantly less than in those without intravesical chemotherapy (22%, P <0.05). Conclusions Smoking is a risk factor for the postoperative recurrence of bladder cancer in renal pelvic and ureteral cancer.Cuff resection of the bladder wall is mandatory and postoperative intravesical chemotherapy would help in the prevention of the postoperative recurrence of bladder cancer.

关 键 词：肾盂癌 输尿管癌 移行上皮癌 术后 复发 膀胱癌 

分 类 号：R737.105[医药卫生—肿瘤] R737.140.2[医药卫生—临床医学]