上尿路尿路上皮癌患者肾输尿管全长切除术后再发膀胱癌的危险因素分析  

Risk factors of the bladder cancer occurrence after radical nephroureterectomy of the upper tract urothelial carcinoma

作　　者：张彩祥 丰琅[1] 田野[1] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,100050

出　　处：《中华泌尿外科杂志》2016年第7期488-492,共5页Chinese Journal of Urology

摘　　要：目的探讨上尿路尿路上皮癌患者行肾输尿管全长切除术后发生膀胱癌的相关危险因素。 方法回顾性分析2013年3－12月收治的61例上尿路尿路上皮癌患者的病例资料，男31例，女30例。年龄43～90岁，平均（69.0±1.1）岁。伴糖尿病17例，高血压病32例。有慢性肾病史12例，肾移植病史7例。7例既往有吸烟史。临床症状表现为血尿者47例，伴腰痛者16例。体重指数（body mass index，BMI）〈18.5 kg/m2 2例，18.5～22.9 kg/m2 25例，23.0～24.9 kg/m2 10例，25.0～29.9 kg/m2 20例，≥30 kg/m2 4例。血肌酐异常25例。术前伴肾积水39例。尿细胞学检测发现肿瘤细胞28例。肿瘤位于左侧36例，右侧25例。肿瘤多发14例，单发47例。肿瘤大小0.5～8.0 cm，平均（2.9±0.8）cm。肿瘤形态为菜花状27例，其他形状34例。术前行输尿管镜检25例。术前诊断为肾盂癌25例，输尿管癌36例，同时伴膀胱癌7例，其中肾盂癌合并膀胱癌1例，输尿管癌合并膀胱癌6例。61例均行腹腔镜下根治性肾输尿管全长切除术＋膀胱袖状切除术，其中6例行膀胱镜下输尿管壁段切除术，55例行开放式输尿管壁段切除术。采用Kaplan－Meier曲线对根治性肾输尿管全长切除术后再发膀胱癌情况做单因素分析，并行Log－rank检验，对单因素分析结果提示的危险因素再行Cox回归分析。 结果本组61例的手术时间为2.0～7.5 h，平均（4.9±1.2） h。病理分期：≥T2期39例，〈T2期22例。病理分级：Ⅰ级2例，Ⅱ级40例，Ⅲ级19例。术后行全身化疗治疗12例，行膀胱灌注23例。本组61例随访22～31个月，平均（27.3±2.7）个月。21例（34.4%）于术后3～30个月再发膀胱癌。术前伴膀胱癌者术后复发4例（57.1%，4/7），未伴发膀胱癌者术后复发17例（31.5%，17/54）。肿瘤多发者术后复发8例（57.1%，8/14），单发者术后复发13例（27.7%，13/47）。≥T2期术后复发18例（Objective To study the clinic features and risk factors of bladder cancer occurrence after radical nephroureterectomy of urothelial carcinoma of the upper tract. Methods 61 cases of urothelial carcinoma of the upper tract from March 2013 to December 2013 in Beijing Friendship Hospital are retrospectively studied. 31 patients are male,while the other 30 patients are female. Age of them ranges from 43 to 90 years old, and the average age is 69 years old. 17 patients are accompanied with diabetes. 32 patients are accompanied with hypertension, 12 patients have the history of chronic nephrosis. 7 patients have the history of renal transplation operation. 47 patients have the symptom of hematuresis. 16 patients have the symptom of lumbago. Body mass index 〈 18.5 kg/m2 2 cases, 18.5 22. 9 kg/m2 25 cases, 23.0 - 24. 9 kg/m2 10 cases, 25.0 - 29.9 kg/m2 20 cases,≥30. 0 kg/m2 4 cases. 25 patients serum ereatinine is abnormal, while the other 36 patients＇is normal. 36 patients have left tumors, while the other 25 patients have right tumors. 39 patients have hydronephrosis before operation. 25 patients go through ureteroscopy. 11 patients have the concurrence of bladder cancer preoperatively. 25 patients have renal pelvic carcinoma, while the other 36 patients have carcinoma of ureter. 14 patients have multiple tumors, while the other 47 patients just have single tumors. The size of tumor ranges from 0. 5cm to 8. 0cm, and the average size is 2. 9cm. 27 patients have the cauliflower-like tumors, while the other 34 patients have other shaped tumors. 28 cases have the positive results of cytology, while the other 33 cases dont have. 6 patients go through cystoscopic operation of nreterovesical junction, while the other 55 patients go through open operation of ureterovesical junction. Kaplan Meier analysis is used to find univariate risk factors of the bladder cancer occurrence postoperatively, and Log-rank test is used after that. Cox regression analysis is used to identify the independent risk factor from all the univar

关 键 词：上尿路尿路上皮癌 膀胱癌 危险因素 

分 类 号：R737.1[医药卫生—肿瘤]