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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。
Objective To investigate the clinical efficacy of preserving renal surgery in primary ureteral cancer. Methods A retrospective analysis of 43 cases of primary ureteral carcinoma in renal pelvis from January 1988 to December 2014 in Chengde Medical College Hospital was performed. Among them, 24 males and 19 females; aged 42 to 84 years old, with an average of 67.3 years old. Tumor occurred in the left ureter 20 side, right ureter 16 sides, bilateral ureteral tumors occurred in 7 cases. 34 tumors occurred in distal ureter, 16 occurred in the upper ureter. Line ureter partial resection end anastomosis 16 sides, the line lower ureter and bladder sleeve resection, ureteral bladder replantation 30 side, 4 side ureteroscopy. Results The patients were followed up for 6 to 312 months, 11 died, of which 5 died of cardiovascular and cerebrovascular diseases; 4 died of other causes, 2 died of cancer metastasis, and the remaining 32 survived. Ureteroscopy recurrence in 1 year, again surgery. Six of them had recurrent tumors in the bladder 6 to 38 months after surgery, all of which survived without tumor after transurethral resection of the urethra. Conclusion It is feasible to preserve renal surgery in patients with low-grade, low-grade primary ureteral tumors. The prognosis is good, but the risk of local recurrence should be followed up closely.