原发性输尿管肿瘤行保留肾脏治疗的临床分析

Clinical study on kidney-sparing surgery in treating the primary transitional cell carcinoma of ureter

目的:探讨原发性输尿管肿瘤行保留肾脏治疗的疗效和安全性。方法:回顾性分析了29例输尿管癌患者保肾治疗的临床资料,输尿管镜下肿物切除术3例,腹腔镜下段输尿管肿瘤切除直接膀胱再吻合5例,中段肿瘤切除行膀胱翻瓣术3例,开放手术行肿瘤切除后输尿管膀胱直接再吻合10例,膀胱翻瓣术5例,输尿管端端吻合3例。术后均行膀胱灌注化疗,3例行全身化疗。结果:病理均为移行细胞癌。分级:低度恶性倾向乳头状瘤4例,低分级乳头状尿路上皮癌13例,高分级12例。临床分期:T15例,T218例,T36例。术后膀胱癌发生率10.3%(3/29),同侧上尿路癌复发3.4%(1/29),尿漏2例,轻度肾积水5例,3例术后死于心肺疾病。在低级别肿瘤,膀胱癌复发率5.9%(1/17),在T1期5例中未见复发,T2期18例中膀胱癌和同侧上尿路癌复发率11.1%(2/18),T3期6例中膀胱癌复发率33.3%(2/6)。结论:保留肾脏术式可以选择性用于单发、低级别或术前影像低分期的中下段输尿管肿瘤,输尿管镜和腹腔镜手术都需加强密切随访。

Objective：To evaluate the clinical safety and efficacy of kidney-sparing surgery in treating the primary transitional cell carcinoma of ureter.Method：The data of 29 cases who underwent kidney-sparing surgery for treatment of the carcinoma of ureter were analyzed retrospectively.There were three cases undergoing endoscopic ablation,eight cases undergoing laparoscopy（five direct ureterocystoneostomies,three reimplantations on Boari flap bladder）,18 cases undergoing open surgeries（ten direct ureterocystoneostomies,five reimplantations on Boari flap bladder,and three end-to-end anastomoses）.All the patients received regular intravesical instillation,and three of them also received intravenous chemotherapy.Result：All the pathology were transitional cell carcinoma,including four papillary urothelial neoplasms of low malignancy,13low-grade papillary urothelial carcinoma,and 12high-grade papillary urothelial carcinoma.Clinical Stage was classified T15,T218 and T36.The recurrence in bladder and ipsilateral upper ureter was 10.3% and 3.4%,respectively.Two cases suffered from urine leak,and five cases had mild hydronephrosis.Moreover,three cases died of heart and lung diseases.The recurrence in bladder was 5.9%in low-grade tumors,and the recurrence in bladder and ipsilateral ureter was 11.1%in T2 tumors,33.3%in T3 tumors.Conclusion：Kidney-sparing surgery is a feasible treatment option for the selected patients with unifocal middle or distal ureteric carcinoma at low grade or without invasive aspect on CT.Laparoscopic ureterocystoneostomy or endoscopic management has more minimally invasive advantages in the treatment.However,a close follow-up is recommended.