57例上尿路上皮肿瘤的诊疗体会

潘峰; 李兵; 范民; 庞自力; 肖亚军; 曾甫清

57例上尿路上皮肿瘤的诊疗体会

- 华中科技大学同济医学院附属协和医院泌尿外科(武汉, 430022)

详细信息

通讯作者: 曾甫清,E-mail:zengfuqingpro@163.com

中图分类号: R737.1

收稿日期: 2012-07-30

Diagnosis and treatment of upper urinary tract urothelial tumor: experience with 57 patients

- Department of Urology, Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

More Information

Corresponding author: ZENG Fuqing, E-mail: zengfuqingpro@163.com

Received Date: 30 July 2012

摘要

摘要: 目的：探讨上尿路上皮肿瘤的临床特征及诊疗经验。方法：回顾性分析我院2002年6月~2007年6月收治的57例上尿路上皮肿瘤患者的临床资料：肾盂肿瘤20例，输尿管肿瘤35例，病变累及肾盂输尿管2例。首发症状为肉眼血尿53例，体检发现4例；术前13例行尿脱落细胞学检查（13/57，22.81%）确诊，33例行B超检查（33/57，57.89%）确诊，28例行IVP检查（28/45，62.22%）确诊，41例行CT检查（41/45，91.11%）确诊，50例行MRU检查（50/52，96.15%）确诊，9例行输尿管镜检查（9/9，100%）确诊。50例行标准根治术，7例行输尿管部分切除术。结果：术后52例获得随访，随访率91.23%。1年和5年肿瘤特异性生存率分别为92.31%（48/52）和59.62%（31/52），其中肾盂肿瘤1年和5年特异性生存率为94.74%（18/19）和68.42%（13/19）；输尿管肿瘤1年和5年特异性生存率为93.55%（29/31）和51.61%（16/31）；2例病变累及肾盂输尿管者，1例术后4个月肿瘤转移死亡，另1例随访6年未见肿瘤复发和转移。本组死亡患者肿瘤分级/分期多为G₂~G₃/T₂~T₃者。结论：肿瘤的分级和分期是预测上尿路上皮肿瘤预后的重要因素；术前行CT、MRU及输尿管镜检查对早期明确诊断有帮助，经积极治疗可提高患者生存率。
- 上尿路肿瘤 /
- 诊断 /
- 治疗
Abstract: Objective: To investigate the clinical features and treatment experience for upper urinary tract urothelial tumor.Method: Fifty-seven patients with upper urinary tract urothelial tumor (renal pelvic carcinoma, n=20; ureter carcinoma, n=35; upper urinary tract involvement, n=2) treated in Union Hospital from June 2002 to June 2007 were enrolled in this retrospective analysis. Gross hematuria was observed in 53 cases. The diagnosis of the patients were confirmed using urine cytology test (22.81%, 13/57),ultrasound(57.89%, 33/57), IVP(62.22%, 28/45), computed tomography(91.11%, 41/45)and/or MRU(96.15%, 50/52), ureteroscopy(100%, 9/9). Fifty cases underwent radical correction and seven cases underwent a surgical excision of the lesion after clearly diagnosed, respectively.Result: Follow-up was available in 52 cases(91.23%), the disease specific survival rate of upper urinary tract urothelial tumor was 92.31%(48/52)at 1 year, 59.62%(31/52)at 5 years. In 19 cases of renal pelvic carcinoma, the disease specific 1-year and 5-year survival rate is 94.74%(18/19)and 68.42%(13/19), respectively. In 31 cases of ureter carcinoma,the disease specific 1-year and 5-year survival rate is 93.55%(29/31)and 51.61%(16/31)respectively. Among the two patients showed upper urinary tract involvement, one died due to metastasis 4 months after surgery, one showed no recurrence and metastasis during the 6-year follow-up. The tumor grade/stage of deaths were mostly G₂-G₃/T₂-T₃.Conclusion: The grading and stages of tumor are important for the prognosis of upper urinary tract urothelial tumor. Computed tomography, MRU and ureteroscopy are helpful for the preoperative diagnosis. Active treatment could improve the survival rate of the patients.
- upper urinary tract tumor /
- diagnosis /
- treatment

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参考文献(12)

[1]	ALAN J W, LOUIS R K, ANDREW C N, et al. Campbell-walsh urology[M]. 10th ed. Philadlphia:Saunders, 2012:1516.
[2]	DAVID K A, MALLIN K, MILOWSKY M I, et al. Surveillance of urothelial carcinoma:stage and grade migration, 1993-2005 and survival trends, 1993-2000[J]. Cancer, 2009, 115(7):1435-1447.
[3]	JEMAL A, TIWARI R C, MURRAY T, et al. Cancer statistics, 2004[J]. CA Cancer J Clin, 2004, 54(1):8-29.
[4]	GREENE F L, PAGE D L, FLEMING I D, et al. AJCC cancer staging manual[M]. 6th ed. New York (NY):Springer-Verlag, 2002:113-124.
[5]	GREENLEE R T, MURRAY T, BOLDEN S, et al. Cancer statistics, 2000[J]. CA Cancer J Clin, 2000, 50(1):7-33.
[6]	ALAN J W, LOUIS R K, ANDREW C N, et al. Campbell-walsh urology[M]. 10th ed. Philadlphia:Saunders, 2012:1518.
[7]	BIRD V G, KANAGARAJAH P. Surgical management of upper tract urothelial carcinoma[J]. Indian J Urol, 2011, 27(1):2-9.
[8]	PARK S, HONG B, KIM C S, et al. The impact of tumor location on prognosis of transitional cell carcinoma of the upper urinary tract[J]. J Urol, 2004, 171(2):621-625.
[9]	MUNOZ J J, ELLISON L M. Upper tract urothelial neoplasms:incidence and survival during the last 2 decades[J]. J Urol, 2000, 164(5):1523-1525.
[10]	SIMSIR A, SARSIK B, CUREKLIBATIR I, et al. Prognostic factors for upper urinary tract urothelial carcinomas:stage, grade, and smoking status[J]. Int Urol Nephrol, 2011, 43(4):1039-1045.
[11]	CHROMECKI T F, BENSALAH K, REMZI M, et al. Prognostic factors for upper urinary tract urothelial carcinoma[J]. Nat Rev Urol, 2011, 8(8):440-447.
[12]	LUGHEZZANI G, BURGER M, MARGULIS V, et al. Prognostic factors in upper urinary tract urothelial carcinomas:a comprehensive yeview of the current literature[J]. Eur Urol, 2012, 62(1):100-114.