高级搜索
肾盂癌的诊断和治疗分析(附92例报告)[J]. 肿瘤防治研究, 2011, 38(08): 933-936. DOI: 10.3971/j.issn.1000-8578.2011.08.020
引用本文: 肾盂癌的诊断和治疗分析(附92例报告)[J]. 肿瘤防治研究, 2011, 38(08): 933-936. DOI: 10.3971/j.issn.1000-8578.2011.08.020
Diagnosis and Treatment of Renal Pelvis Carcinoma (Report of 92 Cases)[J]. Cancer Research on Prevention and Treatment, 2011, 38(08): 933-936. DOI: 10.3971/j.issn.1000-8578.2011.08.020
Citation: Diagnosis and Treatment of Renal Pelvis Carcinoma (Report of 92 Cases)[J]. Cancer Research on Prevention and Treatment, 2011, 38(08): 933-936. DOI: 10.3971/j.issn.1000-8578.2011.08.020

肾盂癌的诊断和治疗分析(附92例报告)

Diagnosis and Treatment of Renal Pelvis Carcinoma (Report of 92 Cases)

  • 摘要: 目的探讨肾盂癌有效的诊断及治疗方法。 方法回顾性分析我院从2003年1月至2009年l月收治的92例肾盂癌患者的临床资料。本组均行手术治疗,开放性肾、输尿管全段及膀胱袖口状切除术73例(79.3%),其中T1~2患者20例(A组);后腹腔镜联合经尿道电切肾盂癌根治性切除术19例(20.7%)(B组),均为T1~2患者。 结果连续三次尿脱落细胞学检查,有一次阳性者68例(73.9%),三次均阳性者29例(31.5%),IVU、B超和CT对肾盂癌确诊率分别为38.6%(32/83)、78.4%(69/88)、84.6%(66/78)。术后病理移行细胞癌82例,移行细胞并鳞状细胞癌10例。WHO分级:G1 15例、G2 56例、G3 21例。TNM分期:T1 55例、T2 7例、T3 22例、T4 8例。术后获得随访92例,随访率100%,随访时间3~60月,平均38.5月。T1~2患者的3、5年生存率分别为77.4%和54.8%,T3~4患者的3、5年生存率分别为26.7%和13.3%。T1~2和T3~4患者的3、5年生存率分别比较,差异有统计学意义(P<0.05)。A、B两组比较术中出血量、术后引流量、肠功能恢复时间、术后住院时间等差异有统计学意义(P<0.05),而肿瘤大小、手术时间差异无统计学意义(P>0.05)。 结论血尿是肾盂癌最常见的症状,尿脱落细胞学检查、IVU、B超检查应作为常规检查,上尿路逆行造影可以作为IVU检查的补充检查方法,CT检查对本病诊断率高,可以作为进一步检查措施。肾盂癌的早期诊断和治疗对患者的长期生存至关重要。肾、输尿管全段及膀胱袖口状切除是治疗本病的首选方法,与传统的开放性肾盂癌根治性切除术相比,后腹腔镜联合经尿道电切肾盂癌根治性切除术虽然技术难度大,但其具有微创、恢复快等优点并且对T1~2患者的治疗,临床疗效相同。

     

    Abstract: ObjectiveTo discuss the diagnostic and therapeutic methods of renal pelvic carcinoma. MethodsWe retrospectively analyzed the clinical and follow-up data of 92 patients with renal pelvic carcinoma.52 cases were male.Mean age was 64 years ranged from 41 to 82 years. Carcinoma was located at left in 49 cases and right in 43 cases.All patients were treated surgically. 73 cases were open nephroureterectomy with bladder cuff excision (20 cases of T1~2,group A), and 19 cases were nephroureterectomy with of bladder cuff excision using retroperitoneal laparoscopy plus transurethral resection (19 cases of T1~2,group B). ResultsOne time positive of the urine cytology was 68 cases (73.9%),and three times positive was 29 cases (31.5%). Ratios of final diagnosis of renal pelvic carcinoma by intravenous pyelogram (IVU),B ultrasound and computed tomography (CT) were 38.6%(32/83), 78.4%(69/88)and 84.6%(66/78),respectively.The pathological type of 82 cases was transitional cell carcinoma,and of 10 cases was squamous cell carcinoma with transitional cell carcinoma.According to WHO grade, 15 cases was grade Ⅰ,56 cases was grade Ⅱ and 21 cases was gradeⅢ.TNM clinical stages were 55 cases with stage Ⅰ,7 cases with stage Ⅱ 22 cases withstage Ⅲ and8 cases with stageⅣ.100% cases were followed up and mean follow-up time was 38.5 months, ranged from 3 to 60 months.The 3-year and 5-year survival rates of stage Ⅰ~Ⅱ cases were 77.4% and 54.8%,respectively and significantly higher than those of stage Ⅲ~Ⅳ cases (26.7% and 13.3%,respectively), P<0.05.In group B,blood loss during operation,postoperative drainage, intestinal function,recovery after operation,hospital stay,transfusion and use of anodyne were significantly reduced than those in group A (P<0.05),while the tumor size and operating time were no significantly different (P>0.05) between two groups. ConclusionsHematuria was the most common symptom of renal pelvic carcinoma.Urine cytology,IVU and B ultrasound should be used as a routine examination for renal pelvic carcinoma. Retrograde pyelography or CT might be a useful adjuvant examination when IVU showed negative results.Early diagnosis and treatment of renal pelvic carcinoma were critical for long-term survival.Nephroureterectomy with bladder cuff excision was the preferred treatment,although retroperitoneal laparoscopy plus transurethral resection afforded an improved postoperative course with minimal invasion,fast recovery . The effective cancer control for patient with Ⅰ~Ⅱ stage tumor was similar between 2 surgical methods.

     

/

返回文章
返回