CAJ | 학술논문

目的探讨原发性下段输尿管尿路上皮癌保肾手术的可行性和适应证. 方法回顾性分析2001 - 2009年收治的108例原发性下段输尿管尿路上皮癌患者资料.男75例,女33例.年龄42～85岁,平均62岁.根据手术方式分为保肾手术(kidney-sparing surgery,KSS)组(27例)和根治性肾输尿管切除手术( radical nephroureterectomy,RNU)组(81例),比较2组患者临床病理资料及随访结果,分析2种术式术后肿瘤复发率的差异. 结果 KSS组Ta期3例均无复发；T1期8例,复发1例(12.5％)；T2期11例,复发4例(36.4％)；T3期5例,复发4例(80％).RNU组Ta期6例均无复发；T1期26例,复发4例(15.4％)；T2期30例,复发10例(33.3％)；T3期19例,复发7例(36.8％).2组Ta～T2期肿瘤复发率比较差异无统计学意义(P＞0.05),KSS组T3期肿瘤复发率明显高于RNU组,差异有统计学意义(P＜0.05).KSS组G1级肿瘤复发1例(33.3％),G2级3例(18.8％),G3级5例(62.5％)；RNU组G1级肿瘤复发2例(22.2％),G2级9例(20.0％),G3级10例( 37.0％)；KSS组G1～G2级肿瘤复发率与RNU组比较差异无统计学意义(P＞0.05),KSS组G3级肿瘤复发率明显高于RNU组,差异有统计学意义(P＜0.05). 结论低分期分级原发性下段输尿管尿路上皮癌行KSS手术安全可行.
목적 탐토원발성하단수뇨관뇨로상피암보신수술적가행성화괄응증. 방법 회고성분석2001 - 2009년수치적108례원발성하단수뇨관뇨로상피암환자자료.남75례,녀33례.년령42～85세,평균62세.근거수술방식분위보신수술(kidney-sparing surgery,KSS)조(27례)화근치성신수뇨관절제수술( radical nephroureterectomy,RNU)조(81례),비교2조환자림상병리자료급수방결과,분석2충술식술후종류복발솔적차이. 결과 KSS조Ta기3례균무복발；T1기8례,복발1례(12.5％)；T2기11례,복발4례(36.4％)；T3기5례,복발4례(80％).RNU조Ta기6례균무복발；T1기26례,복발4례(15.4％)；T2기30례,복발10례(33.3％)；T3기19례,복발7례(36.8％).2조Ta～T2기종류복발솔비교차이무통계학의의(P＞0.05),KSS조T3기종류복발솔명현고우RNU조,차이유통계학의의(P＜0.05).KSS조G1급종류복발1례(33.3％),G2급3례(18.8％),G3급5례(62.5％)；RNU조G1급종류복발2례(22.2％),G2급9례(20.0％),G3급10례( 37.0％)；KSS조G1～G2급종류복발솔여RNU조비교차이무통계학의의(P＞0.05),KSS조G3급종류복발솔명현고우RNU조,차이유통계학의의(P＜0.05). 결론 저분기분급원발성하단수뇨관뇨로상피암행KSS수술안전가행.
Objective To discuss the indication for kidney-sparing surgery (KSS) on primary urothelial carcinoma of the distal ureter. Methods Clinical data of 108 patients with primary urothelial carcinoma of the distal ureter in our hospital from 2001 to 2009 were analyzed retrospectively.There were 75 males and 33 females with mean age of 62 ( range from 42 to 85 ) years old in this study.The patients were divided into KSS group and RNU group according to the operation methods.The recurrence rate of radical nephroureterectomy (RNU) and KSS were evaluated. Results The recurrence was seen none with T,stage,1 (12.5％) with T1 stage,4 (36.4％) with T2 stage and 4 (80％) with T3 stage in KSS group.In RNU group,there was none with Ta stage,4 ( 15.4％ ) with T1 stage,10 (33.3％) with T2 stage and 7 (36.8％) with T3 stage recurred.There was no difference between patients with Ta to T2 stages in KSS and RNU group (P ＞0.05 ) on recurrence,but there was a significant difference between patients with T3 stage (P＜0.05).There was 1 (33.3％) case with G1 grade,3 (18.8％) with G2 grade and 5 (62.5％) with G3 grade recurred in KSS group,while 2 (22.2％) cases with G1 grade,9 (20％) with G2 grade and 10 (37.0％) with G3 grade recurred in RNU group.There was no difference between patients with G1 to G2 grades in KSS and RNU group (P＞0.05),but there was a significant difference between patients with G3 stage in the two groups ( P ＜ 0.05 ). Conclusion KSS seems to be safe for patients with low stage and low grade primary urothelial carcinoma of the distal ureter.