上尿路移行细胞癌两种开放手术疗效比较

Conservative versus radical surgery for transitional cell carcinoma of the upper urinary tract

目的：研究上尿路移行细胞癌（ＴＣＣ）两种开放手术与术后５年生存率、术后复发率的关系。方法：本组共有４５例经病理检查证实的上尿路移行细胞癌，失访４例，因其它疾病死亡２例，３９例被纳入本研究。病理分级按ＷＨＯ法分为Ⅰ、Ⅱ、Ⅲ级；临床分期按Ｊｅｗｅｔ法分为Ｏ、Ａ、Ｂ、Ｃ、Ｄ期。其中低级（Ⅰ～Ⅱ）２０例，高级（Ⅲ）１９例；低期（Ｏ－Ｂ）２１例，高期（Ｃ－Ｄ）１８例。手术方式：根治手术２１例，保守术式１８例。结果：３９例患者术后５年生存率为５３．８％，其中根治组５年生存率为５２．４％，保守性手术组５５．６％，两组比较Ｐ＞０．０５。术后５年内ＴＣＣ复发率两种术式无明显差异。结论：上尿路ＴＣＣ分层比较两种术式在Ｃ期的术后５年生存率有显著差异，分期是决定手术方式选择与预后的最主要的因素。膀胱是术后复发率最高部位，输尿管残端ＴＣＣ应予重视。

Objetive:To determine the result of conservative versus radical surgery for transitional cell carcinoma of the upper urinary tract,depend on the postoperative 5 years survival rates and recurrence rates.Methods:A total of 45 patients with upper urinary tract transitional cell carcinoma (TCC)were recorded.39 cases were acquired follow -up and were analysed.Pathologic grade were 20 at -,19 at ;clinic stage were 21 of A-B,18 of C.Total nephro-ureterectomy (radical) have been performed in 21cases and partial nephroureterectomy (conservative)in 18. Results:Overall,5-years survival rates was 53.8% and for total and partial were 52.4% and 55.6%,respectively. P >0.05.Recurrence rates was similar to different methods of the operation. Bladder TCC was common with upper urinary tract TCC synchronously or asynchronously.Ureteral stump TCC was discoved in 4 cases.Conclusions:Conservative versus radical surgery were apparent difference on stage C for postoperative 5-years survival and it was not different for recurrence rates.Recurrence was related to bladder freguently.Ureteral stump TCC was a important question.The methods of operation shoule be planned individually.