原发性输尿管恶性肿瘤的诊断与治疗(附30例报告)

Diagnosis and treatment of primary ureteral carcinoma(Report of 30eases)

目的 提高原发性输尿管恶性肿瘤的诊治水平。方法 结合文献对 1 974年～ 1 999年收治的 30例原发性输尿管恶性肿瘤的临床特点、诊断、治疗及预后进行回顾性分析并进行讨论。结果 30例中 2 6例行手术治疗 ,术后均经病理证实。首发症状以肉眼血尿最常见 ,尿路造影 (IVU)、B超、膀胱镜、逆性输尿管肾盂造影、CT及输尿管镜检查是主要的诊断方法 ,术前诊断符合率 93.3% ( 2 8/ 30 )。结论 术前联合应用B超、尿路造影 (IVU)、逆性输尿管肾盂造影、膀胱镜及CT ,MRI等检查方法可提高原发性输尿管恶性肿瘤的正确诊断率 ,其中以逆行输尿管肾盂造影的诊断符合率最高。肾 -输尿管全长及膀胱袖状切除术仍是其经典术式 ,且其预后主要取决于肿瘤之分期。

Objective To improve the standard preopreative diagnosis and treatment of primary ureteral carcinoma.Methods The clinical charateristics,diagnostic methods,treatment and prognosis of 30 cases of primary ureteral carcinoma from 1976 to 1999 were retrospectively analyzed and discussed with literature Results 26 patients with ureteral carcinoma had undergone surgery,who were proved pathologically to be positive after operation.The common symptom was painless gross hematuria.The main diagnostic methods were intravenous urography(IVU),ultrasound,cystoscopy,retrograde ureteropyelography,ureteroscopy,and the preoperative diagnosis corresponding rate was 93.3%(28/30).Conclusions The accuracy of diagnostic rate of primary ureteral carcinoma can be improved by the combined use of urography,ultrasonagraphy,retrograde pyelography,CT scanning,MRI,cystoscopy.Retrograde ureteropyelography is the most sensitive among the various examination methods.The traditional total rephroureterectomy with a cuff excision of the urinary bladder is the first choice,and the prognosis of primary ureteral carcinoma correlates well with the grade, and espacially the stage. [