123例上尿路移行细胞癌的临床分析

Clinical Analysis of 123 Cases of Transitional Cell Carcinoma (TCC) of Upper Urinary Tract

背景与目的:随着影像学诊断技术的进展及内窥镜的应用,近年来上尿路移行细胞癌的早期诊断及治疗方法得到明显改善,但争议较大。本文旨在探讨上尿路移行细胞癌合适的诊断及治疗方法。方法:回顾性分析我院自1996年3月至2003年12月收治的123例上尿路移行细胞癌患者的临床资料。结果:B超、静脉肾盂造影(intravenous pyelogram,IVP)、CT对肾盂癌诊断率分别为82.1%、37.1%、88.1%,对输尿管癌诊断率分别为11.8%、3.2%、93.8%。成功行上尿路逆行造影者肾盂癌及输尿管癌病灶均能准确定位。手术治疗116例,姑息治疗7例。获随访107例,随访率为87.0%,平均随访期3.5年,浅表性(T1)以及浸润性(T2,T3,T4或N1,N2)肾盂癌患者的3年生存率分别为94.1%和73.6%,5年生存率分别为88.2%和43.3%;浅表性以及浸润性输尿管癌患者的3年生存率则分别为100%和68.8%,5年生存率分别为80%和40.6%。23.6%的患者出现再发膀胱肿瘤。结论:IVP结合B超检查应作为该病的常规检查;上尿路逆行造影可作为IVP检查不显影者的补充检查方法;CT可作为进一步的检查措施。肾输尿管全切除术是治疗本病的首选方法。

BACKGROUND & OBJECTIVE: With the development of diagnostic techniques of imaging, and application of endoscope, early diagnosis and treatment of transitional cell carcinoma (TCC) of upper urinary tract have been improved to a great extent in recent years, but still caused debates. In this article, we discussed the diagnostic and therapeutic methods of TCC of upper urinary tract. METHODS: Clinical data of 123 patients with TCC of upper urinary tract treated in our hospital from Mar. 1996 to Dec. 2003 were retrospectively analyzed. RESULTS: Ratios of final diagnosis of renal pelvic cancer (RPC) by B ultrasound, intravenous pyelogram (IVP), and computed tomography (CT) were 82.1% (46/56), 37.1% (20/54), and 88.1% (37/42), respectively; those of ureter cancer were 11.8% (4/34), 3.2% (1/31), and 93.8% (15/16), respectively. Successful retrograde pyelography could locate both kinds of carcinomas accurately. Of 123 patients, 116 underwent radical surgery, and 7 given up for metastasis or poor heart and lung function; 107(87.0%) were followed-up with a mean of 3.5 years. Three-year survival rates of patients with superficial RPC (stage T1), and invasive RPC (stages T2-T4, or N1, N2) were 94.1%, and 73.6%; 5-year survival rates were 88.2%, and 43.3%. Three-year survival rates of patients with superficial ureter cancer, and invasive ureter cancer were 100%, and 68.8%; 5-year survival rates were 80.0%, and 40.6%. Bladder tumor occurred in 29 (23.6%) patients. CONCLUSIONS: Combination of IVP and B ultrasound should be used as a routine examination for TCC of upper urinary tract. Retrograde pyelography may be used as an adjuvant examination when IVP showed negative results, CT may be used for further examination. Radical resection of kidney and ureter is the preferred treatment for this disease.