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目的:探讨输尿管癌腔内治疗(endoscopic resection,ER)的手术方法及治疗效果。方法:回顾性分析19例输尿管癌患者的腔内治疗过程:19例患者平均年龄65岁,其中输尿管上段肿瘤4例,中段2例,下段13例;肿瘤平均直径0.9 cm,基底平均宽度0.5 cm。19例患者中,13例行输尿管镜下电切除术,深达输尿管深肌层;6例位于输尿管膀胱壁段肿瘤患者行经尿道电切除术(transurethral resection,TUR),切除肿瘤及输尿管开口周围1.0～1.5 cm正常膀胱黏膜,深达膀胱深肌层。均烧灼肿瘤基底,其中17例术后放置双J管4～8周。结果:手术均顺利,平均手术时间22.9 min,平均出血量18 ml,术后3天内拔除尿管出院。肿瘤分期分级:1例为T_aG_1,8例为T_1G_1,4例为T_1G_2,4例为T_(2a)G_2,2例为T_(2b)G_3。术后1周血Cr平均降低10.22μmol/L,BUN平均降低1.37 mmol/L。随访4～67个月,无膀胱输尿管反流与肾积水,2例T_(2b)G_3患者分别于术后26个月、55个月输尿管局部肿瘤复发,再次行输尿管镜下肿物电切除术,2例于术后3年继发同侧输尿管开口附近膀胱癌。结论:低级别、窄基底的输尿管癌可选择性的行ER,手术微创、安全有效,患者恢复快,预后佳。
Objective: To investigate the surgical treatment and treatment of endoscopic resection (ER) in ureteral carcinoma. Methods: Nineteen patients with ureteral carcinoma were retrospectively analyzed. The average age of 19 patients was 65 years. Among them, 4 were upper ureteral tumors, 2 were middle ones, and 13 were lower ones. The average diameter of tumors was 0.9 cm and the average width of basal tissue was 0.5 cm . Of the 19 patients, 13 underwent transurethral resection of the ureteroscope to reach deep urethral muscular layer. Six patients with tumors in the wall of the bladder wall underwent transurethral resection (TUR). Tumors were resected around the ureteral opening ~ 1.5 cm normal bladder mucosa, deep deep bladder muscle layer. All of the tumor bases were burned, of which 17 cases were placed double J tube for 4 to 8 weeks. Results: The operation was smooth with an average operation time of 22.9 min and an average blood loss of 18 ml. The catheter was removed within 3 days after operation. Tumor stage classification: 1 case of T_aG_1 8 cases of T_1G_1, 4 cases of T_1G_2, 4 cases of T_ (2a) G_2, 2 cases of T_ (2b) G_3. Blood Cr reduced 10.22μmol / L on average after 1 week, and B37 decreased 1.37 mmol / L on average. Followed up for 4 to 67 months without vesicoureteric reflux and hydronephrosis, and 2 cases of T_ (2b) G_3 patients relapsed after 26 months and 55 months respectively. The ureteroscopic resection of ureter Surgery, 2 cases of secondary ipsilateral ureteral orifice in 3 years after the close of bladder cancer. Conclusions: Low-grade, narrow-base ureteral carcinoma can be selectively treated with ER, minimally invasive surgery, safe and effective, rapid recovery and good prognosis.