保留肾脏手术治疗原发性输尿管癌的临床疗效分析

Clinical effectiveness analysis of kidney-sparing surgery for treatment of primary ureteral cancer

目的:分析保留肾脏手术治疗原发性输尿管癌的治疗效果。方法:回顾性分析我院2007年1月～2015年12月行输尿管癌手术患者的临床资料,其中行保留肾脏手术治疗原发性输尿管癌患者共12例,其中11例单发,1例双侧同时发病;位于下段肿瘤12例,中段1例;行输尿管下端及膀胱袖口状切除、输尿管膀胱再植术5例,输尿管镜下钬激光腔内切除5例,行输尿管节段切除、输尿管端端吻合术1例,1例双侧输尿管下段肿瘤患者行双侧输尿管节段切除+输尿管皮肤造口术。术中均留置输尿管支架管,术后1个月拔出,9例术后行膀胱灌注。结果:全部患者均为尿路上皮癌。术后随访3～108个月,平均(48.08±32.75)个月,术后总体复发率为54.55%(6/11),平均无瘤生存时间为(24.2±19.46)个月,2年内膀胱癌发生率为9.0%;2年总体生存率为81.81%(9/11),5年生存率为54.54%(6/11)。结论:保留肾脏手术治疗原发性输尿管癌安全、可行、有效,但术后需严密监测随访,包括输尿管镜检查。

Objective：To explore and analyse the tumour outcome of primary ureteral cancer treated by kidneysparing surgery.Method：The cases of primary ureteral cancer from January 2007 to December 2015 in Peking University Shougang Hospital were reviewed and analyzed.Of 12 cases of primary ureteral cancer treated by kidneysparing surgery,11 cases were found unifocal,one was found bilateral,12 were found distal ureter and one was found middle ureter.The distal ureterectomy plus bladder cuff excision and ureteral neocystostomy were performed in five cases.Ureteroscopic ablation with holmium laser conducted in five cases.One case was performed with segmental ureterectomy and ureteroureteral anastomsis.One patient with bilateral ureteral tumor synchronically was carried out by removing bilateral distal ureter and cutaneous ureterostomy.All the cases were indwelt with ureteral stent tube,and the tube was removed four weeks postoperatively.Of them,nine cases were performed with cystic irrigation.Result：All of them were urothelial carcinoma.Except one withdraw,11 cases were followed up from 3 to 108 months with the mean of（48.08±32.75）months.The total recurrence rate was 54.55%（6/11）,while the average cancer-free survival was（24.2±19.46）months.The incidence of bladder cancer within two years postoperatively was 9.0%.The two-year overall survival was 81.81%（9/11）and five-year overall survival was 54.54%（6/11）.Conclusion：The kidney-sparing surgery treating primary ureteral cancer is safe,feasible and effective.However,the strict surveillance and follow-up should be conducted in the patients after operation,including ureteroscopic exam.