保留肾脏手术治疗原发性输尿管癌临床疗效分析

Clinical effect of kidney-sparing surgery for primary ureteral carcinoma

摘要:

目的  探讨原发性输尿管癌保留肾脏手术的临床疗效。方法  回顾性分析承德医学院附属医院1988年1月-2014年12月对原发性输尿管癌43例做了保留肾脏的手术治疗。其中，男性24例，女性19例；年龄42～84岁，平均67.3岁。肿瘤发生在左输尿管20侧，右输尿管16侧，双侧输尿管同时发生肿瘤7例。34侧肿瘤发生在远段输尿管，16侧发生在中上段输尿管。行输尿管部分切除端端吻合术16侧，行输尿管下段及膀胱袖状切除、输尿管膀胱再植30侧，4侧行输尿管镜手术。结果  随访6～312个月，死亡11例，其中5例死于心脑血管疾患；4例死于其他原因，2例死于癌转移，其余32例均存活。输尿管镜手术在1年内均复发，再次切开手术。其中6例在术后6～38个月膀胱再发肿瘤，均经尿道肿瘤切除后无瘤存活。结论  对低级、低期的原发性输尿管肿瘤保留肾脏手术是可行的。其预后良好，但有局部复发的危险，应密切随访。

Abstract:

Objective To explore the clinical efficacy of kidney-sparing surgery for primary ureteral carcinoma. Methods From January 1988 to December 2014, 43 cases of kidney-sparing surgery for primary ureteral carcinoma were retrospeclively investigated. There were 24 males and 19 females with the mean age of 67.3 years. Twenty cases were located in the left ureter, 16 in the right, and 7 patients had tumor in both sides at the same time. A number of 34 sides got tumor in the distal ureter and 16 sides in the middle and upper segment ureter. Among all 50 sides, 16 sides underwent ureteral segmental resection and end-to-end anastomosis, 30 sides underwent distal ureteral segmental resection with bladder cuff excision and reimplantation on the bladder, and 4 sides underwent electric bright under the ureteroscope. Results The follow-up time was 6-312 months. Death occurred in 11 cases, of which 5 cases died of cardiocerebrovascular disease, 4 cases died of other causes, 2 cases died of cancer metastasis, and the rest 32 cases survived. Recurrence occurred in all the patients underwent ureteroscopy surgery in 1 year. Recurrence of bladder tumor happened in 6 cases in 6-38 months. Conclusions Kidney-sparing surgery is a feasible treatment option in patients with lower stage and grade of primary ureteral carcinoma. It provides good prognosis, but also has a risk of recurrence.