原发性输尿管癌的诊断(附50例报告)

Diagnostic experience of primary ureteral carcinoma (Report of 50 cases)

目的:提高原发性输尿管癌术前诊断水平。方法:对1973～1997年收治的50例原发性输尿管癌的诊断经验进行总结。结果:50例均作IVU检查,其中31例患侧肾脏不显影,仅有7例显示输尿管充盈缺损或狭窄。26例行逆行造影,有16例输尿管充盈缺损或狭窄。48例作B超检查,有43例显示肾积水,35例显示输尿管扩张积水,25例显示输尿管低回声或略强回声的实质性肿物。27例作CT检查,有17例显示输尿管软组织密度实质性肿物。44例作膀胱镜检查,有8例肿瘤自输尿管管口脱出,11例患侧输尿管管口喷血。47例作尿脱落细胞学检查,阳性率为40.4%。结论:术前联合应用IVU、B超、逆行造影、CT、膀胱镜和尿脱落细胞学等检查可提高原发性输尿管癌的正确诊断率。

Purpose:To evaluate preoperative diagnosis of primary ureteral carcinoma.Methods:The diagnostic experiences of 50 cases of primary carinoma of ureter were analyzed from 1973 to 1997.Results:All 50 cases were examined with urography,nonfunctional kidney with carcinoma of uteter was found in 31 patients.However,uerteral filling defect or stricture was seen in only 7.The retrograde ureterogram was better way of revealing the persence of ureteral filling defect.The retrograde ureterogram was performed in 26,the filling defect or stricture was detected in 16.Ultrasonagrapy was carried out in 48 cases.The ultrasonagraphy showed hydronephrosis in 43 and dilatation of ureter in 35,ureteral hypoecho or much less than hyperecho solid mass was detected in 25.CT scanning of the ureter was performed in 27,showing soft tissue density solid mass in 17.Cystoscopy was used in 44,showing tumor in ureteral orifice in 8 and finding hematuria from ureteral orifice with carcinoma of ureter in 11.Exfoliative cytology was performed in 47,postitve rate was 40.4 %.Conclusions:The accuracy diagnostic rate of primary ureteral carcinoma can be improved through the combined use of urography,ultrasonagraphy,retrograde pyelography,CT scanning,cystoscopy and exfoliative ctytology.