输尿管镜治疗上尿路尿路上皮癌的中期随访结果

The mid-term outcomes of ureteroscopic management of upper urinary tract urothelial cancer

目的探讨输尿管镜腔内治疗上尿路尿路上皮癌(UTUC)的可行性及效果。方法 2006年7月至2016年6月,回顾性收集输尿管镜治疗的UTUC患者19例。孤立肾和功能性孤立肾共7例(4/3),对侧健肾功能正常10例。术前活检均为UTUC,低级别15例、高级别4例。采用硬性或软性输尿管镜进行肿瘤切除,记录相关临床参数并给予常规、影像及内镜随访观察。患者分为姑息性手术组和选择性手术组,比较二组差别。结果 10例为姑息性手术、9例为选择性手术。手术共23次,4例进行分期手术或再次探查。Ⅱ级及以上并发症共8例次;中位和平均随访为31月和(32.6±13.3)月。8例共11次复发,中位和平均复发11月和(15.5±13.4)月。总体复发率为42.1%(低级别30%、高级别肿瘤55.6%,P=0.260),2例接受肾输尿管全程切除手术,死亡4例,两组肿瘤大小、位置、术后病理级别和复发等无显著区别。3年总体生存率78.9%,肿瘤特异性生存88.2%,总体器官保存率73.5%。结论输尿管镜腔内手术切除是针对UTUC的一种选择方式,可以安全有效地开展,即使是对侧肾脏功能良好者。术后肿瘤分级和分期有可能变化,高复发率要求严密和长期的随访。多中心研究对探究内镜手术在治疗UTUC的地位有重要意义。

Objective To investigate the feasibility and effectiveness of ureteroscopic management for upper urinary tract urothelial cancer （UTUC）. Methods The clinical data of 19 UTUC cases treated during July 2006 and June 2016 were retrospectively analyzed,including 7 solitary or functionally solitary kidney,2 bilateral lesions,and 10 unilateral cases.UTUC was confirmed by biopsy,including 15 low grade and 4 high grade.The patients were grouped into imperative and selective subgroups.Ureteroscopic management was applied.During the follow-up,the key parameters were recorded. Results Of all 19 patients,10 were included in the imperative subgroup and 9 in the selective subgroup,with no difference in tumor size.Altogether 23 operations were performed,as 4 cases received staged procedures.During the median and average follow-up of 31 months and （32.6±13.3）months,grade Ⅱ or above complications occurred in 8 cases,and 11 recurrences occurred in 8 cases,leading to 2 radical nephroureterectomy and 4 deaths.The 3-year overall survival was 78.9 % ,3-year cancer specific survival was 88.2 % ,and overall kidney preservation was 73.5 % . Conclusions Ureteroscopic management for UTUC is feasible and effective,even for patients with a healthy contralateral kidney.However,this procedure is technically demanding,and the high recurrence rate requires a vigilant and long-term follow-up.Multi-center collaboration is important to elucidate the status of ureteroscopic treatment of UTUC.