摘要
目的提高原发性输尿管癌的诊断和治疗水平。
方法对浙江大学医学院附属第一医院2004年至2007年收治的32例确诊为原发性输尿管癌患者的诊断方法和治疗方法及预后进行回顾性分析。
结果原发性输尿管肿瘤患者32例,其中男19例(59.4%),女13例(40.6%)。年龄44—90岁,平均70.4岁。病程1周至2年,平均6.4月。32例均行B超检查,23例B超(BUS)检查均提示患侧不同程度的肾积水,5例发现输尿管内低回声团块;16例行静脉肾盂造影(IVU),8例病变侧不显影,7例提示肾积水、输尿管充盈缺损;膀胱镜检查28例,发现肿块突入膀胱6例,患侧输尿管口喷血17例;逆行插管11例,逆行造影发现输尿管充盈缺损3例,3例狭窄;CT检查19例,发现输尿管腔内软组织肿块15例;MRU检查6例,均显示输尿管腔截断性梗阻征象。尿细胞学检查15例,阳性4例;3例输尿管镜检查,发现输尿管内乳头状赘生物,后取活检送病理均证实为移行细胞癌。32例原发性输尿管癌均接受手术治疗,包括肾输尿管切除术并膀胱袖式切除术30例,输尿管切除并膀胱部分切除+肾造瘘术1例,输尿管下段切除+输尿管膀胱再植术1例。32例术后均经病理检查证实为原发性输尿管移行细胞癌。术后肿瘤分期Ⅰ期3例,Ⅱ期18例,Ⅲ期9例,Ⅳ期2例。术后肿瘤分级G1-2级6例,G2-3级19例,G3级以上7例。26例获得随访,随访时间6—42个月,3年内死亡者3例,其中1例死于肿瘤复发,肿瘤为高期高级别,2例死于心脑血管意外;23例均存活,其中生存3年以上者10例,均为接受肾、输尿管全长+膀胱袖口状切除术治疗者。
结论原发性输尿管癌的诊断应结合病史及联合应用B超、CT、MRI、膀胱镜及输尿管镜检查以提高诊断率。原发性输尿管癌以手术治疗为主,经典术式为患侧肾、输尿管及膀胱袖口状切除术。但对于孤立肾、对侧肾功能不全、不能耐受手术或双侧上尿路肿瘤等不适于行经典术式的患者以及早期、低期低级肿瘤的患者,可采用保留肾脏的保守性手术,术后应加强随访。
Objective To improve the diagnosis and treatment of primary ureteral cancer.
Methods A retrospective analysis of diagnosis,treatment and prognosis of 32 cases of primary ureteral cancer which was in the First Affiliated Hospital from 2004 to 2007.
Results Between 2004 and 2007 32 patients underwent primary ureteral cancer in our department.The patients consisted of 19 males and 13 females.The range of age was 44 to 90,the history of disease was 1 week to 2 years.All cases were confirmed ultrasound,of which 5 cases were examined tumor in ureter and 23 cases were examined hydronephrosis.16 cases were confirmed intravenous pyelography,of which 8 cases did not develop images in involved kidney and ureter,and 7 cases developed images of filling defect in ureteral lumens.11 cases were confirmed retrograde pyelograph,of which 6 cases developed images of filling defect or stricture in ureteral lumens.19 cases were confirmed CT,of which 15 cases were detected tumors of soft tissue in lumens.6 cases were confirmed MRU,all of which developed images of interrupting obstruction in ureteral lumens.In 15 cases of receiving examination of exfoliocytology,4 cases expressed positive.Examination of cystoscope were given to 28 cases,of which 6 cases were detected neoplasm in ureteric orifice,and 17 cases were detected jetting blood in ureteric orifice.Examination of ureteroscope was given to 3 patients,of which 3 patients were detected tumor in ureter,and later the tumors were all confirmed transitional cell carcinoma by pathological examination.All cases recepted operation.27 cases were given operation of cutting the involved kidney,total length ureter,and urinary bladder like cuffs,1 case was given operation of cutting inferior part of ureter and part urinary bladder and transplantation of ureter and urinary bladder,and 1 case was given operation of cutting the total length ureter,part of the bladder and nephrostomy.32 cases proved to be transitional cell carcinoma by pathological section after operation,of which 3 cases wereⅠstage,18 cases wereⅡstage,9 case wereⅢstage,2 cases wereⅣstage;6 cases were G1-2,19 cases were G2-3,7 cases were over G3.26 cases had been followed-up for 6 to 42 months.3 patients died within 3 years,of which 1 patient died of relapse of tumor,and the cancer was high stage and high grade.2 patients died of accidents.23 patients were still alive,in which 10 patients were still alive after 3 years,who were given operation of cutting the involved kidney,total length ureter,and urinary bladder like cuffs.
Conclusion The diagnose of primary ureteral cancer should combine the history with ultrasound,CT,MRI,cystoscope,and ureteroscope to improve the diagnose.Primary ureteral cancer is mainly treated with operation,which is usually cutting the involved kidney,total length ureter,and urinary bladder like cuffs.But as to patients who are not fit to receive the classic operation style such as solitary kidney,renal inadequacy in the opposite kidney,intolerant to operation or tumors of upper urinary tract exist in both sides,conservative operation of reserving kidney can be used,and follow-up should be strengthened.
引文
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