原发性输尿管癌的诊治分析(附32例报告)

The diagnosis and treatment of primary ureteral cancer( report of 32 cases)

目的：提高原发性输尿管癌的诊治水平。方法收集2004年7月至2014年6月淮北市人民医院收治的32例原发性输尿管癌病例，归纳分析诊治中的若干问题。本研究男19例，女13例；年龄51～79岁，平均年龄64岁，其中上段输尿管癌11例（34.4%），中段5例（15.6%），下段16例（50.0%），病程3～24个月，平均5个月。32例患者均采用手术治疗，其中26例行开放式标准根治术（肾、输尿管及输尿管膀胱入口处袖状切除）；2例行后腹腔镜肾及中上段输尿管切除术（输尿管下段及膀胱入口处袖状切除同开放式手术）；4例晚期输尿管下段肿瘤因与盆壁和髂血管广泛粘连固定并侵入膀胱，行姑息性肾、部分输尿管切除术。结果本研究32例手术均顺利完成，手术时间90～195 min，平均140 min，术中出血量130～700 mL，平均310 mL，围术期无严重并发症；术后病理提示，移行细胞癌30例（93.7%），鳞状细胞癌2例（6.3%）；组织学病理分级为G1期4例，G2期15例，G3期13例；16例获得随访，1年内死亡1例，死于肝肺转移继发恶液质；5年内死亡3例，其中2例术后2年随访期内发生膀胱肿瘤，均再行全膀胱切除术＋输尿管造口术，1例术后1年均死于全身转移，另1例死于肾功能衰竭；12例生存5年以上，5年生存率为75%。结论原发性输尿管癌早期诊断较困难，联合应用多种检查方法可明显提高术前确诊率；根治性肾、输尿管及输尿管膀胱入口处袖状切除仍是治疗原发性输尿管癌的首选方法。

Objective to improve the diagnosis and treatment of primary ureteraL cancer. Methods Summarized the experi-ence of diagnosis and treatment of 32 cases of primary ureteraL cancer,incLuding 26 cases of open radicaL gastrectomy and 2 cases of retroperitoneaL Laparoscopic renaL and upper ureteraL and 4 cases of paLLiative ureter resection operation,from JuLy 2004 to June 2014. SeveraL aspects of the diagnosis and treatment were probed into. Results there were 32 cases to be successfuLLy opera-ted. the mean operating time was 140 minutes（90-195 min）and the mean bLood Loss during the operation was 310 mL（130-700 mL）,without major compLications. Sixteen cases were foLLowed up,1 case died during 1 years,3 cases died during 5 years, 12 cases survived over 5 years. the 5-year survivaL rate was 75%. Conclusion It is difficuLt to make a diagnosis in the earLy stage of primary ureteraL cancer,which may be improved by combination of various kinds of tests. RadicaL nephroureterectomy with bLadder mucosaL cuff resection shouLd be the first choice in the treatment of primary ureteraL cancer.