原发性输尿管癌诊治24例报告

Diagnosis and treatment of primary ureterai cancer(report of 24 cases)

目的提高输尿管癌的诊治水平。方法回顾性总结1990年1月至2005年3月收治的24例原发性输尿管癌患者的临床资料。男19例,女5例。年龄38～72岁,平均年龄59岁。左侧16例,右侧8例。肉眼血尿17例(71%),镜下血尿7例(29%)。尿细胞学检查16例,阳性1例。B超提示肾盂积水19例(79%),提示中下段输尿管低回声占位3例(12%)。IVU提示肾盂积水20例(83%),患侧输尿管充盈缺损3例(12%)。逆行肾盂造影检查21例,插管不成功5例,输尿管充盈缺损16例(76%)。CT检查20例,提示输尿管内软组织肿块14例(70%)。螺旋C T薄层扫描3例均确诊。MRU3例,确诊1例。结果24例均进行手术治疗,18例行肾、输尿管全长加膀胱袖状或膀胱部分切除,6例行肾切除加输尿管部分切除。术后病理报告移行细胞癌23例,腺癌1例。1990-1999年的14例中存活1、2、3、4、5、6年者分别为1、5、3、2、2、1例。2000-2005年的10例中,失访3例,术后存活1、3年者各2例,3例存活未满5年者仍在随访中。结论IVU、逆行肾盂造影检查仍是原发性输尿管癌最常用的基本诊断方法,联合其他影像学检查可减少漏诊。本组病例由于手术时病理分期偏晚,5年生存率较低。

Objective To improve the diagnosis and treatment of ureteral cancer. Methods A retrospective analysis of 24 cases of primary ureteral cancer treated from January 1990 to March 2005 was performed. The diagnostic value of ultrasound, IVU, CT, MRU and the patients＇ outcomes were reviewed. There were 19 males and 5 females aged 38 -72 years （mean,59 years）. The tumors were on the left side in 16 cases and on the right in 8. Of the 24 cases, 17 （71%） had gross hematuria and 7 （29%） had microscopic hematuria. Urine cytology was performed in 16 cases with a positive rate of 6.3%. B-ultrasonic examination showed hydronephrosis in 19 cases （79%） and low-echo space-occupying disease of middle-inferior ureter in 3 （ 12% ）. IVU demonstrated hydronephrosis in 20 cases （83%） and filling defect of the diseased ureter in 3 （12%）. Retrograde pyelography showed filling defect of the diseased ureter in 16 （76%） of 21 cases （5 cases had failure of intubation）. CT scan was performed in 20 cases, indicating thickening of the ureteral wall and infiltration of the cancer in 14 （70%）. In 3 cases who had undergone spiral CT thin layer scan and 1 of 3 cases who had undergone MRU, the definite diagnosis was made. Results All the 24 patients underwent surgical treatment. Among them, nephroureterectomy and bladder cuff or partial resection were performed in 18 cases, and nephrectomy and partial ureterectomy in 6 cases. Postoperative pathology showed transitional cell carcinoma in 23 cases, and adenoma in 1. Of the 14 cases during 1990 - 1999 period, 1,5,3,2,2 and 1 cases had survival time of 1,2,3,4,5 and 6 years, respectively. Of the 10 cases during 2000 -2005 period,3 were lost to follow-up;2 survived for 3 years and 2, for 1 year; the other 3 who have survived near 5 years have been followed till now. Conclusions IVU and retrograde urography are the most common diagnostic measures for primary ureteral cancer. They can be used in combination with other imaging study to reduce missed diagnosis rate. The 5-year survival rate was lower because of late pathologic stage of the tumors in the patients of this series.