内镜下钬激光治疗早期上尿路上皮肿瘤特殊病例10例报告

Endoscopic Holmium Laser Treatment for Early Upper Urinary Tract Carcinoma: A Study of 10 Special Cases

目的探讨内镜下钬激光治疗特殊早期上尿路上皮肿瘤的安全性及有效性。方法 2002年4月～2010年5月,对10例不适合行根治性肾输尿管切除术的早期上尿路上皮肿瘤患者行内镜下钬激光治疗,其中输尿管肿瘤7例(1例合并膀胱肿瘤),肾盂肿瘤3例。单发7例,多发3例。术前肿瘤分期cTa～cT1。3例对侧已行肾输尿管全长切除,2例孤立肾,3例肾功能不全,1例2～3级心功能不全,1例肿瘤小(<1 cm,位于肾盂,单发且表浅)。输尿管硬镜治疗7例,软镜1例,微通道经皮肾镜2例。术后行丝裂霉素上尿路及膀胱灌注化疗。结果 10例术后随访2年,无肿瘤死亡。1例术后6个月输尿管狭窄,其余均未出现大出血、严重感染、周围脏器损伤及全身肿瘤转移。复发4例,其中1例输尿管合并膀胱肿瘤者膀胱内复发,1例为肾盂内单发肿瘤复发,2例为输尿管单发肿瘤复发。该4例随访5年,1例未见肿瘤复发与转移,3例复发3～4次,且为尿路多处复发,行肾盂输尿管癌根治术,其中2例术后血液透析1年内肿瘤转移死亡。结论对不适合行根治性肾输尿管切除术的早期上尿路上皮肿瘤,内镜下钬激光治疗短期内是安全有效的。

Objective To assess the efficacy and safety of the endoscopic holmium laser treatment for special early upper urinary tract carcinoma. Methods The clinical data of 10 cases of primary upper urinary tract carcinoma from April 2002 to May 2010, who were unsuitable for nephroureterectomy, were reviewed, of which 7 cases were ureteral Cancers （1 case combined with bladder tumor） , and 3 cases were tumors of the renal pelvis. There were 7 single cases and 3 multiple cases. The preoperational classification of the tumors was in the range of cTa - cT1. 3 cases had experienced contralateral nephroureterectomy, 2 cases were solitary kidney, 3 cases were diagnosed as renal insufficiency, 1 had 2 - 3 grade cardiac dysfunction, and 1 case was small tumor （ 〈 1 cm, located in the renal pelvis, solitary and superficial）. In terms of endoscopic treatment, 7 cases received rigid ureteroscopy, 1 underwent flexible ureteroscopy, and 2 received mini-percutaneous nephroscopy. Mitomycin chemotherapy was applied postoperatively in all cases through irrigation of bladder and upper urinary tract. Results A 2-year follow-up showed that among the 10 cases, no one died of tumor, 1 had ureteral stricture 6 months after the operation, and the rest had no severe complications such as severe hemorrhage, infection, shock, abdominal organ injury and systemic metastasis. 4 cases got recurrence, among which, 1 patient developed bladder cancer, 1 patient had recurrence of renal pelvic carcinoma, and 2 had ureteral carcinoma. During the 5-year follow-up, 1 patient had not shown tumor recurrence and metastasis, 3 patients were performed nephroureterectomy for carcinoma of the renal pelvis and ureter due to the repeated multiple ureter recurrence, of which 2 patients died of tumor metastasis lyear after the operation. Conclusion The treatment of endoscope with holmium laser is an effective and safe technique for special early upper urinary tract carcinoma detection, especially for low-grade ones.