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目的提高原发性输尿管恶性肿瘤的早期诊治水平。方法总结13年间收治的28例原发性输尿管恶性肿瘤患者。男∶女为18∶10,平均年龄61岁。左侧20例,右侧5例,双侧2例,单侧多中心1例。肉眼血尿占64.3%,镜下血尿占35.7%。超声提示肾盂积水23例、输尿管低回声占位15例。IVU提示肾盂积水16例、输尿管充盈缺损6例。成功逆行肾盂造影检查26例,输尿管充盈缺损23例。螺旋CT扫描阳性率为78.6%(22/28)。IVU显示不清8例患者MRU检查均显示患侧肾积水并见充盈缺损。结果28例均行手术治疗,11例行肿瘤局部输尿管切除术,8例行肾切除加输尿管部分切除,5例行输尿管下段切除膀胱移植术,4例行肾、输尿管全长加膀胱袖状或膀胱部分切除。术后病理报告移行细胞癌26例,腺癌1例,鳞癌1例。前7年的13例中,失访2例,存活2,3,5,6,8年者分别为1,3,4,1,2例,>5年生存率为63.6%。后6年的15例中,失访1例,术后存活1,3,5,7,10年者分别为2,3,5,3,1例,>5年生存率为64.2%。结论超声是发现肾积水的敏感方法,尤其在体检中能早期发现,肾积水成为早期诊断输尿管肿瘤的重要线索。IVU、螺旋CT是追查肾积水的基本检查,逆行肾盂造影是诊断输尿管癌不可缺少的有创深入检查,MRU可弥补IVU和逆行肾盂造影检查的缺陷。本组患者由于发现较早,肿瘤分期分级低,5年生存率较高。
Objective To improve the early diagnosis and treatment of primary ureteral malignancies. Methods A total of 28 patients with primary ureteral malignant tumor who were treated in 13 years were summarized. Male: Female 18:10, average age 61 years old. Left in 20 cases, right in 5 cases, bilateral in 2 cases, unilateral polycentric in 1 case. Gross hematuria accounted for 64.3%, microscopic hematuria accounted for 35.7%. Ultrasound prompted hydronephrosis in 23 cases, ureteral hypoechoic accounted for 15 cases. IVU prompted hydronephrosis in 16 cases, ureteral filling defect in 6 cases. Successful retrograde pyelography in 26 cases, ureteral filling defect in 23 cases. The positive rate of spiral CT scan was 78.6% (22/28). IVU showed unclear 8 patients MRU examination showed hydronephrosis and see the filling defect. Results Twenty-eight patients underwent surgical resection. Twenty-one patients underwent partial nephroureterectomy, eight underwent nephrectomy plus ureterotomy, five underwent transurethral resection of the bladder and four underwent renal and ureteral full-length plus bladder sleeve or Bladder partial resection. Postoperative pathological report of 26 cases of transitional cell carcinoma, adenocarcinoma in 1 case, squamous cell carcinoma in 1 case. Among the 13 cases in the first 7 years, 2 cases were lost to follow-up, 1,3,4,1,2 and 3 years, 5 years, 6 years and 8 years respectively. The survival rate of 5 years was 63.6%. Among the 15 cases after 6 years, 1 patient was lost to follow-up, and 2,3,5,3 and 1 were survived at 1, 3, 5, 7 and 10 years respectively. The 5-year survival rate was 64.2%. Conclusion Ultrasound is a sensitive method to detect hydronephrosis, especially in the early detection of physical examination, hydronephrosis as an important clue to early diagnosis of ureteral tumors. IVU, spiral CT is to trace the basic examination of hydronephrosis, retrograde pyelography is an indispensable diagnostic invasive ureteral invasive examination, MRU can make up for IVU and retrograde pyelography defects. This group of patients as found earlier, low-grade tumor stage, 5-year survival rate higher.