上尿路移行细胞癌的腔内治疗

Endourological treatment of transitional cell carcinoma in upper urinary tract

目的探讨上尿路移行细胞癌的腔内保守治疗疗效以及远期随访结果。方法对6例上尿路移行细胞癌患者进行腔内治疗，5例逆行输尿管镜下电切配合钬激光烧灼，1例顺行经皮肾电切处理。结果随访1～4年，1例肾盂移行细胞癌患者术后5个月复发，合并严重出血，行患侧肾输尿管切除。1例肾盂移行细胞癌以及1例输尿管移行细胞癌患者复发，每3～6个月复诊行输尿管镜下钬激光烧灼，另外3例患者未见肿瘤复发。结论对于解剖或者功能性孤立肾、双侧上尿路肿瘤、肾功能不全、合并严重疾病不能耐受开放手术者以及对侧肾正常但患侧肿瘤直径小于1．5cm且级别较低患者，腔内治疗是理想的一种治疗选择。但所有患者术后都需要进行严格的随访。

Objective To evaluate the outcome of endoscopic management of upper - tract transitional cell carcinoma（TCC）. Methods Six patients with upper -tract TCC were treated by an en- doscopic approach as the primary management：5 cases by semi -rigid or flexible ureteroscopy and 1 case by percutaneous technique. Treatment consisted of electrocautery only in 1 case,holmium ： YAG laser in 5 cases. Results In the follow up less than 4 years, 1 case with renal TCC received nephrostomy for recurrence with severe bleeding,2 cases with repeat TCC recurrence received regular ureteroscopy and Ho：YAG laser aalation,3 cases were cured with single endoscopic treatment. Conclusion Conservative treatment of endoacopy was feasible for patients with bilateral TCC disease, a solitary kidney, or co - morbidities that contraindicate to major surgery,low - stage disease 〈 15 mm in diamete with normal contralateral kidneys. All thesse cases whould be provided with adequate endoscopic follow- up.