原发性输尿管癌的诊治分析

Diagnosis and Treatment of Primary Ureteral Cancer

目的探讨原发性输尿管癌的临床诊治特点及预后因素,提高对原发性输尿管癌的认识。方法对61例经手术病理证实的原发性输尿管癌的临床资料进行回顾性分析研究。结果原发性输尿管癌最常见的症状是血尿。比较彩超、CTU、输尿管镜检查结果表明,CTU和输尿管镜的诊断符合率高。61例均行手术治疗,以输尿管癌根治术为主(55/61,90.2%)。结果均为尿路上皮癌。术后病理结果均为尿路上皮癌。61例获得随访,术后5年生存率为52.5%。结论原发性输尿管癌少见且预后不佳。无痛性肉眼血尿是原发性输尿管癌的最常见的症状。原发性输尿管癌早期诊断较困难,多种方法联合检查可有效提高临床诊断率,治疗首选肾、输尿管全长及膀胱袖状切除术。对不能耐受大手术、孤立肾、慢性肾功能不全的患者,输尿管部分切除术是可选择的手术方式。肿瘤的分期和分级是影响其预后的重要因素,低分期、低分级的原发性输尿管癌预后更好。

Objective To discuss the diagnosis, therapy and prognosis of primary ureter cancer and elevate the theory about primary ureteral carcinoma. Methods Retrospectively analyze the data of 61 cases were proved with ureteral cancer by pathology. Resutls The most common symptom of primary ureteral cancer is hematuria. Campared with color ultrasonography,CTU and ureteroscopy vere much more accurate. All the cases underwent surgical operations, and total nephroureterectomy was performed in 55 cases of patients, accounted for 90.2% （55/61）. 61 patients were urological epithelial carcinoma. All the 61 cases were followed up. 5 years survival rate was 52.5%. Conclusion Primary ureteral carcinoma is rare and its prognosis is poor. Painless gross hematuria is the most common symptom of primary ureteral carcinoma. Early diagnosis of primary ureteral cancer is diffcult. Combined examination with multiple methods can effectively improve the clinical diagnosis rate. Nephrectomy, total ureteral resection and sleeve cystectomy are the frst choice for treatment of primary ureteral cancer. Partial ureteral resection is an alternative method for patients who cannot tolerate major surgery, isolated kidney and chronic renal insuffciency. The staging and grading of tumors are important factors affecting their prognosis. Primary ureteral cancer with low grade and low grade has better prognosis.