保留肾脏术式治疗原发性输尿管癌临床分析

Kidney-sparing surgery to treat the primary transitional cell carcinoma of ureter

目的探讨保留肾脏术式治疗输尿管癌的临床疗效。方法回顾性分析了保留肾脏术式治疗原发性输尿管癌的19例患者,其中男性10例,女性9例,平均年龄65.6岁。无痛性肉眼血尿14例,腰痛2例;B超偶然发现肾积水3例。结果 19例患者均行保留肾脏手术。行输尿管部分切除、输尿管端端吻合术的患者4例;输尿管下端及膀胱袖口状切除、输尿管膀胱再植术的患者11例;输尿管镜下切除的患者4例。病理均为移行上皮细胞癌,病理分级:G15例;G28例;G2～G33例;G33例。分期:Ta 1例;T15例;T29例;T34例。17例病例获得随访(89.5%),5年生存率为58.8%(10/17)。术后6个月～2年膀胱癌发生率29.4%(5/17);术后1年～6年同侧上尿路癌复发者29.4%(5/17)。3例患者于术后1～3年死于内科疾病。结论原发输尿管癌为少见的尿路上皮肿瘤,预后不佳。对低分级、低分期的肿瘤保留肾脏术式预后良好,但保肾手术有复发的风险,需密切随访。

Objective To evaluate the clinical treatment and prognosis of the primary transitional cell carcinoma of ureter. Methods Retrospective review of 19 cases who underwent kidney-sparing surgery for treatment of the primary transitional cell carcinoma of ureter was carried out. There were 10 males and 9 females with the mean age of 65.6 years. 14 cases had gross hematuria and 2 cases had flank pain and in 3 cases renal hydronephrosis was found incidentally by B-uhrasound. Results All cases were treated with kidney-sparing surgery. In 15 cases ureteral segmental resection was performed, in 4 of these cases terminoterminal anastomosis and in 11 cases ureterocystostomy with bladder cuff excision were performed. In 4 cases tumor were resected by ureteroscopy. Postoperative pathological findings confirmed the diagnosis of transitional cell carcinoma. Pathological staging showed Ta （ 1 cases ） , T1 （ 5 cases ）, T2 （ 9 cases ）, T3 （ 4 cases ） and grading showed Gl （5 cases） ; G2 （8 cases） ; G2-G3 （ 3 cases） ; G3 （ 3 cases）. Seventeen cases （ 89.5 % ） were followed up for 3 - 132 months. The overall 5-year survival rate was 58.8%. Bladder recurrences occurred in 29.4% of patients within 6 - 24 post-operation months and 29.4% patient showed ipsilateral upper urinary tract transitional cell carcinoma recurrences within 12 - 72 post-operation months. Three cases died of non-tumor illness within 12 - 36 months postoperatively. Conclusion The primary transitional cell carcinoma of ureter may be uncommon and has poor prognosis. Kidney-sparing surgery is a feasible treatment option in patients with lower stage and grade. The long-term follow up should be meticulous, because the recurrence rate is high.