多器官尿路上皮肿瘤的诊断与治疗

Diagnosis and treatment of urothelial tumors in multiple organs

目的探讨多器官尿路上皮肿瘤的诊疗经验。方法回顾性分析10例多器官尿路上皮肿瘤患者的临床资料。术前合理选用B超、静脉尿路造影（IVU）、行。肾盂造影（R-P）、泌尿系造影（CTU）、泌尿系成像（MRU）、膀胱镜、输尿管镜等检查提示同时有2个或2个以上尿路器官发生尿路上皮肿瘤。结果6例行根治性患侧肾、全输尿管切除术及膀胱部分切除术；3例行根治性患侧肾、全输尿管切除术及膀胱全切除术加尿流改道术；1例行患侧输尿管末段切除术、膀胱全切除术。目前8例存活，其中1例发生后尿道肿瘤行尿道全切除术；2例分别于术后18个月和32个月死亡。结论应用超声、IVU、R-P、CTU、MRU、膀胱镜、输尿管镜检查等对多器官尿路上皮肿瘤的诊断具有重要意义。应根据肿瘤分期和级别及患者的情况，选择不同的手术方式。术后应加强监测、密切随访。

Objective To explore the experiences of the diagnosis and treatment of urothelial tumor in multiple organs. Methods Clinical data of 10 patients with urothelial tumor in multiple organs were retrospectively reviewed. Urothelial tumors were found in two or more organs at the same time by B ultrasound, IVU, R-P, CTU, MRU, cystoscopy, ureteroscopy and so on before operation. Results 6 cases were operated by radical total nephroureterectomy and partial cystectomy, 3 cases were operated by radical total nephroureterectomy and cystectomy with urinary diversion, 1 case was operated by partial ureterectomy and total cystectomy. 8 of them were alive, 1 case was operated by total urethrectomy because of tumor recurrence in the posterior urethra, one died of metastasis tumor 18 months after operation, and the other died 32 month after operation. Conclusions Combined use of various kinds of the diagnostic means （ultrasound, IVU, R-P, CTU, MRU, cystoscopy, ureteroscopy） are important for the diagnosis of urothelial tumor in multiple organs. It needs to select the operate mode according to the tumor staging and grade and the patient＇s condition. Reinforcement surveillance and close follow up is required after operation.