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目的:分析原发性输尿管肿瘤患者的临床资料,进一步丰富诊疗经验。方法:对2014~2015年我科收治的45例原发性输尿管肿瘤患者的临床资料进行回顾性分析。结果:45例患者术前均行B超、CT,部分患者行膀胱镜+逆行造影、输尿管镜等检查诊断为输尿管肿瘤。45例患者全部行手术治疗,其中27例行根治手术,18例行保肾手术,术后病理证实44例为尿路上皮癌,1例为腺癌。术后随访14个月~3年,术后1年总生存率91.1%(41/45),术后2年总生存率85.0%(34/40),术后3年总生存率66.7%(14/21),其中27例行根治手术者11.1%(3/27)于术后3年内死亡;18例行保肾手术者22.2%(4/18)于术后3年内死亡。结论:联合影像学检查和内镜检查可以提高输尿管肿瘤的诊断准确率。肾及输尿管全长切除+输尿管口膀胱袖套状切除术是治疗原发性输尿管肿瘤的首选方法,其中腹腔镜手术较开放手术具有术中出血少、术后恢复快等优势。原发性输尿管肿瘤的预后与病理分级及疾病分期密切相关。
Objective: To analyze the clinical data of patients with primary ureteral tumor to further enrich the experience of diagnosis and treatment. Methods: The clinical data of 45 patients with primary ureteral tumors admitted to our department from 2014 to 2015 were analyzed retrospectively. Results: 45 patients underwent preoperative ultrasound B, CT, some patients underwent cystoscopy + retrograde angiography, ureteroscopy and other tests diagnosed as ureteral tumor. Forty-five patients underwent surgery, of which 27 underwent radical surgery and 18 received kidney-preserving surgery. Postoperative pathology confirmed that 44 were urothelial carcinomas and 1 was adenocarcinoma. The patients were followed up for 14 months to 3 years. The 1-year overall survival rate was 91.1% (41/45), the 2-year overall survival rate was 85.0% (34/40) and the 3-year overall survival rate was 66.7% Among them, 11.1% (3/27) of 27 patients undergoing radical surgery died within 3 years after surgery; 22.2% (4/18) of 18 patients undergoing kidney therapy died within 3 years after operation. Conclusion: Joint imaging and endoscopy can improve the diagnostic accuracy of ureteral tumors. Full-length resection of the kidney and ureter + ureterocele sleeve cuff resection is the preferred method of treatment of primary ureteral tumors, of which laparoscopic surgery has the advantages of less intraoperative bleeding and faster postoperative recovery than open surgery. The prognosis of primary ureteral tumors is closely related to the pathological grade and disease stage.