关于高龄原发输尿管癌手术方式的探讨

Investigation of the Choice between Surgical-treatment of Primary Ureteral Cancer in Eldly Patiants

目的:探讨高龄原发性输尿管癌患者手术方式的潜在生命风险及其预后。方法:回顾性分析我院自1996年～2010年77例70～89岁高龄原发输尿管癌患者的相关资料,其中42例接受保留肾脏的局部肿瘤切除术(A组),35例接受标准根治术(B组),并对两种术式进行比较。结果:77例术后病理诊断为原发输尿管癌,根治术患者手术时间平均为2小时20分钟,术后并发心衰、肺部感染、肺栓塞5例,围手术期死亡2例。保肾局部肿瘤切除术平均手术时间为1小时15分,术后除一例发生肺部感染外,无其它并发症和围手术期死亡病例。随访6～61个月复发13例,其中局部切除术后复发7例,根治术后复发6例。结论:高龄输尿管癌患者行标准根治手术在围手术期出现并发症或死亡明显高于保肾局部手术患者。故对高龄输尿管癌合并症较多的患者选择保肾局部肿瘤切除术不失为安全有效的方法,且肿瘤复发率与标准根治手术无显著性差异。

Objective：To evaluate the potential risk and prognosis of surgical-treatment of primary ureteral cancer in eldly patients.Methods：77 patients with upper urinary tract tumors who were treated surgically at our hospital from 1996 to 2010,aged 70 to 89,were retrospectively reviewed.42 were received nephron-sparing surgery（A）,35 standard-radical surgery（B） as a comparison group.Results：The pathology-diagnose of all patients was primary ureteral cancer.The mean surgical-time of A was 1 hour and 15 minute,with a pneumonia but no other syndrome and death.however,the mean time of B was 2 hour and 20 minute,with 5 heart failure,pneumonia and pulmonary embolism,2 death.The time of following-time was 6-61 month,associating with 13 recrudescence,A（7）,B（6）.Conclusion：The pattern of surgery for primary ureteral cancer in old patients is not significant.In our study,the outcome of nephron-sparing surgery is slightly better than nephrour-eterectomy surgery,notability improve the current quality of life,and reduce the time of postoperative recuperation.