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目的探讨同时性尿路上皮多器官肿瘤的临床特点,提高诊治效果。方法对获随访的65例同时发生于多个尿路器官的尿路上皮肿瘤进行回顾性总结。男39例,女26例。年龄45~79岁,平均66岁。肾盂癌合并输尿管癌21例,输尿管癌合并膀胱癌17例,肾盂癌合并膀胱癌14例,同时合并肾盂输尿管膀胱癌13例。T16例,T235例,T322例,T42例。G15例,G232例,G328例。随访6个月~14年。结果术前诊断同时存在尿路上皮多器官肿瘤59例(90.8%)。术前诊断准确率B超32.3%(21/65),IVU45.3%(29/64),逆行肾盂造影56.8%(25/44),CT81.5%(53/65),螺旋CT尿路三维重建91.7%(11/12),CT三维重建联合膀胱镜检查100.0%(12/12)。术后再发膀胱癌46例(70.8%),2年内再发36例。G1、G2、G3术后膀胱癌再发率分别为20.0%、81.3%和67.9%,G1与G2~G3两组比较差异有统计学意义(P<0.05)。T1、T2、T3术后膀胱癌再发率分别为66.7%、80.0%和63.6%;T42例均于术后短期内死亡,无膀胱癌再发。术后即时膀胱灌注化疗术后膀胱癌再发率63.2%(12/19),未灌注化疗者73.9%(34/46)。3年生存率41.7%,5年生存率30.6%。结论螺旋CT三维成像加膀胱镜检查是发现同时性尿路上皮多器官肿瘤的良好方法。同时性尿路上皮多器官肿瘤术后容易再发膀胱癌,肿瘤细胞分化不良者术后膀胱癌的再发率高。术后密切观察,建议除定期膀胱镜检查外,尚需行尿路造影检查。
Objective To investigate the clinical features of simultaneous urothelial multi-organ tumor and improve the diagnosis and treatment. Methods A retrospective review was made on the 65 cases of urinary tract epithelial tumors that were concurrently observed in multiple urinary tract organs. 39 males and 26 females. Age 45 ~ 79 years old, average 66 years old. Pelvic cancer with ureteral cancer in 21 cases, ureteral cancer with bladder cancer in 17 cases, renal pelvis cancer with bladder cancer in 14 cases, combined with pelvic ureter in 13 cases of bladder cancer. T16 cases, T235 cases, T322 cases, T42 cases. G15 cases, G232 cases, G328 cases. Follow-up 6 months to 14 years. Results There were 59 cases (90.8%) of urothelial carcinomas concurrently diagnosed before operation. The accuracy of preoperative diagnosis was 32.3% (21/65) in B ultrasound, 45.3% (29/64) in IVU, 56.8% (25/44) in retrograde pyelography, CT 81.5% (53/65), spiral CT urinary tract Three-dimensional reconstruction 91.7% (11/12), CT three-dimensional reconstruction combined cystoscopy 100.0% (12/12). 46 cases of recurrent bladder cancer (70.8%), 36 cases of recurrence within 2 years. The recurrence rates of bladder cancer after G1, G2 and G3 were 20.0%, 81.3% and 67.9%, respectively. The difference between G1 and G2 ~ G3 was statistically significant (P <0.05). The recurrence rates of bladder cancer after T1, T2 and T3 were 66.7%, 80.0% and 63.6% respectively. All T42 patients died within a short period after operation, and no recurrence of bladder cancer was found. The rate of recurrent bladder cancer was 63.2% (12/19) and 73.9% (34/46) in patients who did not receive chemotherapy. The 3-year survival rate was 41.7% and the 5-year survival rate was 30.6%. Conclusions Spiral CT three-dimensional imaging with cystoscopy is a good method to find multiple urinary tract epithelial tumors. At the same time, multiple urinary tract epithelial tumor prone to recurrent bladder cancer, poorly differentiated tumor cells after bladder cancer recurrence rate is high. Close observation after surgery, it is recommended in addition to regular cystoscopy, the need for urography.