低分期和低分级原发性输尿管癌的临床特点分析  

Clinical characters of the primary transitional cell carcinoma of ureter with lower stage and grade

作　　者：张继伟[1] 王海涛[1] 阎乙夫[1] 王建军[1] 白焱[1] 夏溟[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院泌尿外科,100038

出　　处：《中华泌尿外科杂志》2013年第10期742-745,共4页Chinese Journal of Urology

摘　　要：目的探讨低分期和低分级原发性输尿管癌的临床诊治特点及预后。方法回顾性分析1993年1月至2011年12月收治的18例原发性输尿管癌患者的临床资料，男12例，女6例。年龄51～85岁，平均67岁。左侧13例，右侧5例。肿瘤直径0．5～1．5cm，发生于输尿管下段15例，中段3例。病史5d～3个月，平均1．5个月。无痛性肉眼血尿10例，B超检查发现肾积水8例。18例行B超检查，15例。肾盂分离1．0～1．5cm，梗阻上段输尿管扩张0．8～1．0cm，其中8例发现低回声占位病变。15例行IVU检查，其中12例患肾轻度积水，5例输尿管有充盈缺损改变。15例行CT检查，其中10例发现占位病变。18例行膀胱镜检查，5例患侧输尿管口可见肿瘤突入膀胱。13例行逆行造影检查，其中2例插管失败，10例输尿管有充盈缺损改变。4例行输尿管镜检查，发现输尿管肿瘤并取活检明确诊断。结果8例行输尿管癌根治术，10例行保留肾脏手术。保留。肾脏手术包括输尿管末端及膀胱袖状切除、输尿管膀胱再植术5例，输尿管镜下肿瘤切除术3例，输尿管部分切除、输尿管端端吻合术2例。病理诊断均为尿路上皮癌，病理分级：G18例，G210例。病理分期：Ta期1例，T1期8例，T2期9例。16例获随访，随访时间6～132个月。5年生存率87．5％。术后6个月～2年膀胱癌发生率为25％；2例于术后3～4年死于肿瘤复发和转移。结论低分级、低分期的原发性输尿管癌预后良好。保留肾脏手术更适合治疗此类患者，但需密切随访。Objective To discuss the diagnosis, therapy and prognosis of primary ureter transitional cell carcinoma with low stage and grade. Methods Retrospective review of 18 cases surgery to treat the primary ureter carcinoma of G1-2 Ta-2 was carried out. There were 12 males and 6 females with the mean age of 67 years. Of the 18 cases with the size of tumor were from 0.5 to 1.5 cm. 13 cases had the tumors on the left and 5 cases on the right. The tumors were located at middle parts of the ureter in 3 cases, and at the lower part in 15 cases. The course of the disease was from 5 days to 3 months. 10 cases had gross hematuria and 8 cases renal hydronephrosis were found incidentally by B-ultrasound. B-ultrasound was performed in all cases. 15 cases were indicated pyelic separation from 1.0-1.5 cm and ureteral separation from 0.8-1.0 cm. 8 cases were indicated the low-echo space-occupying disease of ureter. IVU indicated mild hydronephrosis in 12 cases of 15 cases, of whom 5 cases were demonstrated a filling defect. CT indicated the mass of ureter in 10 cases of 15 cases. Cystoscope were performed in 18 cases, of whom 5 cases were found the tumor in the ureter-bladder cuff. Retrograde pyelogram showed filling defect of the diseased ureter in 10 of 11 cases （2 cases had failure of intubation）. 4 cases ureteroscopy with biopsy were used and demonstrated the diagnosis. Results 8 cases were treated surgically of radical nephroureterectomy with a bladder cuff excision, 7 cases were performed ureteral segmental resection, of which 2 cases anastomosis and 5 cases ureterocystostomy with bladder cuff excision. 3 cases tumors were resected by ureteroscopy postoperative pathological findings confirmed the diagnosis of transitional cell carcinoma. Pathological staging showed T（ l case） ; T1 （8）, T2 （9） ,and grading showed G1（8）; G2（10）. 16 cases （88.9%） were followed up form 6-132 months. The overall 5-year survival rate was 87.5%. Of the 25% patient showed bladder recurrence in post-operation 6- 24 months. 2

关 键 词：输尿管癌 低分期 低分级 手术 预后 

分 类 号：R737.13[医药卫生—肿瘤]