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目的探讨术中联合125I粒子植入治疗中晚期肾盂、输尿管尿路上皮癌(UUTUC)的疗效。方法回顾分析2004—2009年50例肾盂、输尿管移行细胞癌患者的临床资料。粒子植入组20例行术中直视下瘤床组织间125I粒子植入,单纯手术组30例单纯根治性手术。局部控制率、生存率用Kaplan-Meier法计算并Log-rank法检验及单因素分析,多因素分析采用Cox回归模型。结果单纯手术组、粒子植入组局部复发率分别为37%和10%,差异有统计学意义(P<0.05)。2组生存率无明显差异。单因素和多因素分析显示分期(χ2=15.89,P=0.000)、脉管癌栓(χ2=3.92,P=0.048)与总生存率有关。结论术中联合125I粒子植入治疗中晚期肾盂、输尿管尿路上皮癌是简单、安全、有效的方法,可降低局部复发率,但在改善患者生存方面尚未现优势。T分期较晚及脉管癌栓是预后不良因素。
Objective To investigate the effect of combined intraoperative 125I seed implantation in the treatment of advanced renal pelvis and ureteral urothelial carcinoma (UUTUC). Methods The clinical data of 50 patients with renal pelvis and ureter transitional cell carcinoma from 2004 to 2009 were retrospectively analyzed. In the group of 20 implantation of seeds, 125I seeds were implanted into the tumor bed under direct vision in operation, and 30 patients underwent radical surgery alone in the operation group. Local control rate and survival rate were calculated by Kaplan-Meier method and Log-rank test and univariate analysis, and multivariate analysis was performed by Cox regression model. Results The rates of local recurrence were 37% and 10% respectively in the surgery group and the particle implantation group, the difference was statistically significant (P <0.05). There was no significant difference in survival between the two groups. Univariate and multivariate analysis showed that the staging (χ2 = 15.89, P = 0.000) and vascular tumor thrombus (χ2 = 3.92, P = 0.048) were related to overall survival. Conclusion Intraoperative combination of 125I seed implantation in the treatment of advanced renal pelvis and ureteric urothelial carcinoma is a simple, safe and effective method to reduce the local recurrence rate, but there is no advantage in improving patient survival. T late and vascular thrombosis is an adverse prognostic factor.