不同术式对肾盂输尿管癌术后再发膀胱癌的影响(附94例报告)

Correlation between operative procedures for pelviureteral carcinoma and the postoperative occurrence of bladder carcinoma

目的 探讨肾盂输尿管癌的最佳手术方式及预防术后再发膀胱癌的有效措施。 方法 对 94例采用不同术式治疗肾盂输尿管癌患者术后再发膀胱癌的临床资料进行总结。 结果 单发肾盂或输尿管癌行肾盂输尿管切除术 (未切除壁间段输尿管及管口周围部分膀胱 )术后膀胱癌再发率为 5 4.5 % (6 /11) ,明显高于肾盂输尿管膀胱部分切除术 (2 3.5 % ,12 /5 1)和改良膀胱粘膜袖套状切除法肾盂输尿管膀胱部分切除术 (33.3% ,3/9) ,差别有显著性意义 (P <0 .0 5 ) ;后二者比较差别无显著性意义 (P >0 .0 5 )。肾盂输尿管癌术后再发时间短 ,多位于病侧管口周围。肾盂输尿管多器官癌行肾盂输尿管膀胱部分切除术后膀胱癌再发率为 72 .2 % (13/18) ,与改良膀胱粘膜袖套状切除法肾盂输尿管膀胱部分切除术 6 0 % (3/5 )比较 ,差别无显著性意义 (P >0 .0 5 )。 结论 改良膀胱粘膜袖套状切除法可防止瘤细胞种植 ,是一良好的治疗方法。彻底切除病侧管口周围部分膀胱壁是预防术后再发膀胱癌的关键。

Objective To evaluate the correlation betwe en operative procedures for pelviureteral carcinoma and the occurrence of postop ertive occurrence of bladder carcinoma. Methods 94 cases of pelviureteral carcinoma with postopertive occurrence of bladder carcinoma we re retrospectively studied. Results With nephrouretectom y without cuff resection of the bladder,the postoperative occurrence of bladder carcinoma was 54.5%(6/11),being obviously higher than nephroureterectomy with pa rtial bladder resection (23.5%,12/51) or nephroureterectomy with bladder mucosal cuff resection (33.3%,3/9,P<0.05).Whereas there was no significant differe nce between the latter 2 procedures (P>0.05).The lap between the primary ope ration and the occurrence of bladder carcinoma was usually short and the occurre nce was mostly on the same affected side.In pelviureteral carcinoma with multior gan involvement,the postopertive occurrence of bladder carcinoma was as high as 72.2%(13/15) in spite of nephroureterectomy with partial resection of the bladde r . Conclusions Cuff resection of the bladder on the same side is the key point to prevent postoperative occurrence of bladder carcinoma.T he improved bladder mucosa cuff technique is a sound procedure to prevent tumor cell implantation.