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目的探讨原发性输尿管癌的诊断、治疗、病理学特点和预后。方法对1971年1月至2002年7月我所经手术病理检查诊断为原发性输尿管癌174例患者的临床发病、病理学资料、诊断、治疗及随访结果进行回顾性分析。结果30年来输尿管癌病例数呈明显增加趋势。本组男99例,女75例,平均发病年龄637岁。阳性率较高的术前检查有逆行尿路造影、CT、磁共振水成像、输尿管镜检查,阳性率分别为878%(86/98),960%(48/50),958%(23/24)和870%(20/23)。手术以肾、输尿管全长切除和输尿管入口处膀胱袖状切除术为主,共131例(753%)。组织学分型,移行细胞癌171例(983%),其中Ta～2和G1、2肿瘤各占70%以上(122/174,126/174)。160例(920%)获随访,随访时间2～216个月。术后总的5年生存率531%(52/98),总的10年生存率305%(18/59)。术后发生膀胱癌38例(238%),发生对侧输尿管癌6例(38%)。结论原发性输尿管癌预后不良,肿瘤分期、分级是决定预后的主要因素,应提高术前诊断的准确性。
Objective To investigate the diagnosis, treatment, pathological features and prognosis of primary ureteral cancer. Methods The clinical data, diagnosis, treatment and follow-up results of 174 patients diagnosed as primary ureteral cancer from January 1971 to July 2002 were analyzed retrospectively. Results 30 cases of ureteral cancer showed a significant increase in the number of cases. The group of 99 men and 75 women, with an average age of 637 years old. The positive rate of preoperative examination with retrograde urography, CT, magnetic resonance imaging, ureteroscopy, the positive rates were 878% (86/98), 960% (48/50), 958% (23 / 24) and 870% (20/23). Surgery with kidney, total ureter resection and vesical resection of ureter at the entrance, a total of 131 cases (753%). There were 171 cases of transitional cell carcinoma (983%) with histological type. Among them, Ta ~ 2 and G1,2 tumors accounted for more than 70% (122 / 174,126 / 174). 160 cases (920%) were followed up for 2 ~ 216 months. The overall 5-year survival rate was 531% (52/98) and the overall 10-year survival rate was 305% (18/59). Postoperative bladder cancer occurred in 38 cases (238%), contralateral ureteral cancer occurred in 6 cases (38%). Conclusion The poor prognosis of primary ureteral cancer, tumor staging and grading are the main factors that determine the prognosis, and should improve the accuracy of preoperative diagnosis.