原发性输尿管肿瘤28例临床分析

Early diagnosis of primary ureteral neoplasms： report of 28 cases

目的探讨原发性输尿管肿瘤早期诊断的途径，以提高早期诊治率。方法回顾分析28例输尿管肿瘤临床资料，比较超声检查、静脉尿路造影（IVU）、逆行尿路造影检查（RU）、螺旋CT、MRI、微创腔镜检查、尿液脱落细胞检查等诊断意义。结果阳性率较高的术前检查有RU、螺旋CT、MRI、腔镜检查。28例均行手术治疗，手术以肾、输尿管全长加膀胱袖状或膀胱部分切除为主，共19例。术后病理报告移行细胞癌27例，腺癌1例，其中TI-2肿瘤8例。获得随访25例。1990年至1999年14例存活1、2、3、4、5、6年者分别为1、5、3、2、2、1例。2000年至2007年14例，失访4例，术后存活1、3年者各2例，6例未满5年者仍在随访中。结论早期联合超声、IVU、RU、螺旋CT三维重建、MR]等检查分析是提高早期诊断率的有效途径。一经诊断，尽快手术治疗。

Objective To evaluate the choice of early diagnosis method of primary ureteral neoplasms in order to improve the ratio of clinical diagnosis. Methods 28 cases with primary ureteral neoplasms were retrospectively analyzed. Ultrasonic examination, IVU, retrograde urogram, spiral CT, MRI, ureteroscopy and exfoliative cell examination of urine were compared in this study. Results The most useful methods of detecting tumors preoperation were retrograde urogram, spiral CT, MRI, ureteroseopy. All the 28 patients underwent surgical treatment. Among them, nephroureterectomy and bladder cuff or partial resection were performed in 19 cases. Postoperative pathology showed transitional cell carcinoma in 27 eases, and adenoma in 1 case. 8 cases were T1-2 tumours. 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 14 cases during 2000 -2007,4 were lost to follow-up;2 survived for 3 years and 2 for 1 year;the other 6 who have survived near 5 years have been followed till now. Conclusions To improve the early diagnosis rate, B-ultrasonic examination, IVU ,retrograde urogram,3D spiral CT and MR/examination were necessary in the early stage. The patients should be opeiated as early as possible after diagnosis.