上尿路尿路上皮癌保留肾脏的手术治疗

Kidney sparing surgery for upper tract urothelial carcinoma

上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)是一种相对少见的尿路上皮恶性肿瘤,其更具有侵袭性,60%的患者在诊断时即处于进展期。UTUC的发病呈现显著地域差异,我国UTUC发病率高于西方国家;由于尿路上皮癌具有多中心、易复发的生长特性,传统的肾输尿管全长切除术可能导致患者出现慢性肾脏病甚至需要终身透析,显著降低患者生活质量并影响其远期预后;保留肾脏手术则需要根据患者疾病风险分层慎重选择,避免使其暴露于疾病进展甚至转移风险中;另外,如何降低复发风险也是目前亟待解决的问题之一。

Of all urothelial cancers,the upper tract urothelial carcinoma(UTUC)is relatively rare comparing to bladder cancer but more aggressive in its biological nature,for about 60%of all UTUC patients would be found with locally advanced or metastatic diseases.UTUC has a varied distribution all over the world,and Chinese population has a higher incidence than western population.Since UTUC has the feature of multi-centered and with high recurrence possibility,the conventional radical nephroureterectomy might leads to chronic kidney disease or even worse,cost both kidneys for patients with bilateral diseases and leads them to life-long dialysis,which would significantly lower their quality of life and affect their long-term prognosis.Kidney sparing surgery requires strict patient selection according to disease risk stratification to avoid exposing patients under high risk of disease progression;and as to reducing disease recurrence,the solution is still in exploring.