CAJ | 학술논문

目的探讨低分期和低分级原发性输尿管癌的临床诊治特点及预后. 方法回顾性分析1993年1月至2011年12月收治的18例原发性输尿管癌患者的临床资料,男12例,女6例.年龄51～85岁,平均67岁.左侧13例,右侧5例.肿瘤直径0.5～ 1.5 cm,发生于输尿管下段15例,中段3例.病史5d～3个月,平均1.5个月.无痛性肉眼血尿10例,B超检查发现肾积水8例.18例行B超检查,15例肾盂分离1.0～ 1.5 cm,梗阻上段输尿管扩张0.8～ 1.0 cm,其中8例发现低回声占位病变.15例行IVU检查,其中12例患肾轻度积水,5例输尿管有充盈缺损改变.15例行CT检查,其中10例发现占位病变.18例行膀胱镜检查,5例患侧输尿管口可见肿瘤突入膀胱.13例行逆行造影检查,其中2例插管失败,10例输尿管有充盈缺损改变.4例行输尿管镜检查,发现输尿管肿瘤并取活检明确诊断. 结果 8例行输尿管癌根治术,10例行保留肾脏手术.保留肾脏手术包括输尿管末端及膀胱袖状切除、输尿管膀胱再植术5例,输尿管镜下肿瘤切除术3例,输尿管部分切除、输尿管端端吻合术2例.病理诊断均为尿路上皮癌,病理分级:G1 8例,G2 10例.病理分期:Ta期1例,T1期8例,T2期9例.16例获随访,随访时间6～ 132个月.5年生存率87.5％.术后6个月～2年膀胱癌发生率为25％；2例于术后3～4年死于肿瘤复发和转移. 结论低分级、低分期的原发性输尿管癌预后良好.保留肾脏手术更适合治疗此类患者,但需密切随访.
목적 탐토저분기화저분급원발성수뇨관암적림상진치특점급예후. 방법 회고성분석1993년1월지2011년12월수치적18례원발성수뇨관암환자적림상자료,남12례,녀6례.년령51～85세,평균67세.좌측13례,우측5례.종류직경0.5～ 1.5 cm,발생우수뇨관하단15례,중단3례.병사5d～3개월,평균1.5개월.무통성육안혈뇨10례,B초검사발현신적수8례.18례행B초검사,15례신우분리1.0～ 1.5 cm,경조상단수뇨관확장0.8～ 1.0 cm,기중8례발현저회성점위병변.15례행IVU검사,기중12례환신경도적수,5례수뇨관유충영결손개변.15례행CT검사,기중10례발현점위병변.18례행방광경검사,5례환측수뇨관구가견종류돌입방광.13례행역행조영검사,기중2례삽관실패,10례수뇨관유충영결손개변.4례행수뇨관경검사,발현수뇨관종류병취활검명학진단. 결과 8례행수뇨관암근치술,10례행보류신장수술.보류신장수술포괄수뇨관말단급방광수상절제、수뇨관방광재식술5례,수뇨관경하종류절제술3례,수뇨관부분절제、수뇨관단단문합술2례.병리진단균위뇨로상피암,병리분급:G1 8례,G2 10례.병리분기:Ta기1례,T1기8례,T2기9례.16례획수방,수방시간6～ 132개월.5년생존솔87.5％.술후6개월～2년방광암발생솔위25％；2례우술후3～4년사우종류복발화전이. 결론 저분급、저분기적원발성수뇨관암예후량호.보류신장수술경괄합치료차류환자,단수밀절수방.
Objective To discuss the diagnosis,therapy and prognosis of primary ureter transitional cell carcinoma with low stage and grade.Methods Retrospective review of 18 cases surgery to treat the primary ureter carcinoma of G1-2 Ta-2 was carried out.There were 12 males and 6 females with the mean age of 67 years.Of the 18 cases with the size of tumor were from 0.5 to 1.5 cm.13 cases had the tumors on the left and 5 cases on the right.The tumors were located at middle parts of the ureter in 3 cases,and at the lower part in 15 cases.The course of the disease was from 5 days to 3 months.10 cases had gross hematuria and 8 cases renal hydronephrosis were found incidentally by B-ultrasound.B-ultrasound was performed in all cases.15 cases were indicated pyelic separation from 1.0-1.5 cm and ureteral separation from 0.8-1.0 cm.8 cases were indicated the low-echo space-occupying disease of ureter.IVU indicated mild hydronephrosis in 12 cases of 15 cases,of whom 5 cases were demonstrated a filling defect.CT indicated the mass of ureter in 10 cases of 15 cases.Cystoscope were performed in 18 cases,of whom 5 cases were found the tumor in the ureter-bladder cuff.Retrograde pyelogram showed filling defect of the diseased ureter in 10 of 11 cases(2 cases had failure of intubation).4 cases ureteroscopy with biopsy were used and demonstrated the diagnosis.Results 8 cases were treated surgically of radical nephroureterectomy with a bladder cuff excision.7 cases were performed ureteral segmental resection,of which 2 cases anastomosis and 5 cases ureterocystostomy with bladder cuff excision.3 cases tumors were resected by ureteroscopy postoperative pathological findings confirmed the diagnosis of transitional cell carcinoma.Pathological staging showed Ta(1 case);T1 (8),T2(9),and grading showed G1(8);G2(10).16 cases(88.9％)were followed up form 6-132 months.The overall 5-year survival rate was 87.5％.Of the 25％ patient showed bladder recurrence in post-operation 6-24 months.2 cases died of tumor recurrence and metastasis in post-operation 36-48 months.Conclusions The primary transitional cell carcinoma of ureter was uncommon and has poor prognosis.Ureter carcinoma with lower stage and grade might have better prognosis.Kidney-sparing surgery is a feasible treatment option in patients with lower stage and grade.The long-term follow up is meticulous.