原发性输尿管癌的诊断与治疗

Diagnosis and Treatment of Primary Ureteral Carcinoma

目的：提高原发性输尿管癌的诊断与治疗水平。方法：回顾性分析38例原发性输尿管癌患者的临床资料并结合文献讨论其诊断和治疗。结果：脱落细胞学检查、静脉肾孟造影（IVP）、CT及MRI对本病的确诊率分别为38．1％、9．1％、80．8％、72．7％，38例均行手术治疗，病理检查结果均为移行细胞癌，随访29例，失访9例。随访期6个月～6a。3a生存率为79．5％，5a生存率为71．9％。随访病例中无残留输尿管癌和膀胱癌。结论：各种检查方法有相互补充的作用，IVP检查对本病病灶定位及定性诊断率低，但应作为常规检查。上尿路逆行造影对本病病灶定位准确率高适应于IVP检查失败者。CT及MRI对本病诊断率高，是重要的诊断方法。肾、输尿管和膀胱袖状切除术是主要的治疗方法，对浅表性肿瘤，独肾或对侧肾功能不全者可行输尿管部分切除术。

Objective To improve the diagnosis and treatment of primary ureteral carcinoma. Methods Clinical data of 38 cases of primary ureteral carcinoma were retrospectively analysed and discussed with review of the literature. Resuits Ratio of final diagnosis of primary ureteral transitional cell carcinoma （TCC） by the positive rate of urine cytology, intravenous pyelogram （IVP）, CT scanning, and MRI were 38. 1% ,9. 1% ,80.8% and 72.7 %, respectively. Opera- tion was performed on 38 patients and the diagnosis was demonstrated pathologically. All the patients were follow up for 6 months to 6 years, and no tumor recurred. The 3-year and 5-year survival rate were 79.5% and 71.9% respectively. Conclusions The right rate of diagnosis of IVP for this disease are very poor, but it should be considered as the routine examinations. Retrograde pyelography can improve it further, CT is very important for locating the TCC in the upper urinary tract. There are complementary effects among the examinations. Nephroureterectomy with excision of bladder cuff is the treatment of choice. Resection of a part of ureter were especially for superficial tumor, unitesticle or renal dysfunction on other side.