上尿路上皮肿瘤的治疗(4)
滴注疗法(Instillation Therapy)
考虑使用滴注疗法来治疗上尿路上皮肿瘤，如何是一种奇闻。但Smith等[31](1987)曾报导经膀胱腔内应用丝裂霉素C来治疗伴有膀胱输尿管反流的末端输尿管肿瘤。Dekock及Brytenboch[32](1986)采用局部切除及灌注THIOTEPA到上尿路治疗上皮肿瘤，起到有益的效果，而无其他副作用。BCG也有应用于上尿路肿瘤进灌注治疗，包括原位癌(Remsey 及Soloway[33]1990，Smith等[31]1987，Studer等[34]1989)。BCG已公认取得临床效果较好的方法，但也有部分患者产生脓毒症，(Ramsey 及Soloway[33]1990，Studer[34]1989)。
灌注的途径是逆行输尿管导管或经PCN管给药。有报导曾用于孤立肾而取得较好效果，但一般认为灌注BCG反应较大，应于慎重。
, 百拇医药
放射治疗(Radiation Therapy)
上尿路上皮肿瘤的患者，放射治疗多用于手术后防止高级高期恶性病变的复发。临床实践证实，放射治疗对某些鳞状上皮细胞癌病人是有益的。放射治疗对姑息性治疗骨转移及疼痛也是常用的手段。但报导对上皮肿瘤的数目、大小、它的永久性结论尚不确切。
动脉栓塞(Angioinfarction)
动脉栓塞较少用于上尿路肾盂及输尿管癌，但常用于有症状的原发肿瘤，或伴有远处转移者。
系统化疗(Systemic Chemotherapy)
化疗抗癌药物治疗上尿路上皮肿瘤，似同治疗膀胱上皮癌。国为上尿路上皮癌较少见，目前尚无大量的报导。长期随访应用M-VAC(丝裂-长春花碱、阿霉素、卡帕)曾使之失望，仅5%有永久性疗效。41%病人可产生中性粒细胞缺乏性败血症，有2-3%因此而死亡(Tannock等[35]1989)
, 百拇医药
Scher等[36](1988)曾对一组伴有膀胱外移行上皮细胞癌的患者，应用M-VAC作为一种新的辅助治疗方法。这项研究也包括少数的上尿路移行上皮癌。其报导是不全面的，例如用于治疗膀胱癌的病人，M-VAC对混合组织肿瘤是不敏感的。同样对新的原位病灶的预防，也是不敏感的。
参考文献
1. Murphy. D. M, Zincke, H, Furlow. W. L, primary grade I transitional cell carcinoma of the renal pelvis and ureter. J. Urol. 123: 629.1980.
2. Murphy. D. M, Zincke, H, Furlow. W. L, Managgement of high grade transitional cell cancer of the upper urinary tract. J. Urol. 135: 25. 1981.
, 百拇医药
3. Anderstrom. C., Johansson. S. L, pettersson. S. et al: Carcinoma of the ureter: A cliincopathologic study of 49 cases. J. Urol. 142: 280. 1989.
4. Bloom. N. A,Vidone. R, A, Lytton. B., : primary carcinoma of the ureter: A ieport of 102 New cases. J. Urol. 103: 590 1970.
5. Mullen. J. B., Kovacs, K, primary Carcinoma of the ureteral stump: A case report and a review of the literature, J. Urol. 123: 113. 1980.
, 百拇医药
6. Mufti. G. R., Gove. J. R., Badenoch. D. F., et al: Transitional cell carcinoma of the renal prlvis and ureter. Br. J, Urol. 63: 135. 1989.
7. 杜传军，史时芳：原发性输尿管肿瘤的外科治疗。中华泌尿外科杂志。17：162，1996.
8. 栗山学:肾盂输尿管肿瘤的临床治疗变迁.日泌尿会志. 84(10): 1839. 1993(引自江恩摘,江鱼校. 国外医学. 泌尿系统分册 14: (2)96. 1994.)
9. 潘柏年,薛兆英,郭应禄等:肾盂恶性肿瘤(附161例报告).中华泌尿外科杂志15: (1) 10,1994.
10. 孔垂泽,张铭铮,刘同才等:肾盂输尿管癌术后再发尿路上皮癌中华泌尿外科杂志15: (4)263. 1994.
, 百拇医药
11. Johansson. S Wahlqvist. L.: A prognostic study of urethelial renal pelvic tumors: Comparison between the prognosis of patients treates with intrafascial nephrectomy and peritascial nephrourelerectomy. Cancer. 43: 2525. 1979.
12. Skinner. D. G,: Technipue of nephroureterectomy with regional lymph node dissection. Urol. Clin. North Am. 5: 253. 1978.
13. Babaian. R. J., Johnson. D. E.,: primary Carcinoma of the ureter. J. Urol 123: 357. 1980.
, 百拇医药
14. Batata. M. A.Whitmore. W. F., milaris. B. S., et al: Primary carcinoma of the ureter: A prognostic study. Cancer. 35: 1626. 1975.
15. Davis. B. W., Hough. A. J., Gardner. W. A., Renal pelvic carcinoma: Morphological Correlates of metastic behavior. J. Urol. 137: 857. 1987.
16.郑世广,周志耀,陈承志等:根治性切除治疗上尿路移行上皮癌.中华泌尿外科杂志. 15: (1)56. 1994.
17.Guinan. P., Renal elvic transitional cell carcinoma the role of the kidney in Tumor Node Metastasis Staging Cancer 19: 173 1992.
, 百拇医药
18.Zoretic. S., Gonzales. J.,: primary carcinoma of the ureters. Urolgy 21: 354. 1983.
19.Bazeed. M. A., Scharfe. T., Becht. E., et al: Locol excision of urethelial cancer of the upper urinary tract. Eur. Urol 12: 89. 1986.
20.Hatch. T. R., Hefty. T. R., Barry, J. H.,: Time-related recurrence rates in patents with upper tract transitional cell carcinoma. J. Urol. 140: 40. 1988.
21.Zincke. H., Neves. R. J.,: Feasibility of conservative surgery for transitional cell cancer of the upper urinary tract. Urol. Clin. North Am. 11: 717. 1984.
, http://www.100md.com
22.Ziegelbaum. M., Novick, A. C., Stteem. S. B., et al: Conservative surgery for transitional cell carcinoma of the renal pelvis. J. Urol. 138: 1146. 1987.
23.Johnson. D. E., Babaian. R. J.,: Conservative management for noninvasive distal ureteral carcinoma. Urology 13: 365. 1979.
24.Schoenbery. M. P.,: Management of transitional cell carcinoma of the solitary kidney. J. Urol. 146: 700. 1991.
, 百拇医药 25.Blute. M. L., Segura. J. W., Patterson. D. E., et al: Impact of endourology on diagnosis and management of upper urinary tract Urothilial Cancer. J. Urol. 141: 1298. 1989.
26.Schmeller. N. T., Hofstetter. A. G.,: Laser treatment of ureteral tumors. J. Urol. 141: 840. 1989.
27.Smith. A. Y., Orihuela. E., Crowley. A. R.,: Percutameous management of renal pelvic tumors: A treatment option in selected cases. J. Urol. 137: 852 1987.
, http://www.100md.com
28.Tasca. A., Zattoni, F., The case for a percutaneous approach to transitional cell carcinoma of the renal pelvis. J. Urol. 143: 902. 1990.
29.Nakada. S. Y., Calyman. R.V.,: percutoneous electro vaoriztion of upper tract transitional cell carcinoma in patients with functionally solitary kidney. Urology 46: 751.1995.
30.Patal, A, Soonawalla. P., Shepherd. S. F., et al: Longterm outcame after percutaneous treatment of transitional cell carcinoma of the renal pelvis. J Urol. 155: 868. 1996.
, 百拇医药
31.Smith. A. Y., Vitale. P. J., Lowe. B. A., et al: Treatment of superficial papillary transitional cell carcinoma of the ureter by vasicoureteral reflux of mitomycin. C. J. Urol. 138: 1231. 1987.
32.Dekock. M. L., Breytenbach. I. H.,: Locol excision and topical thiotepa in the treatment of transitional cell carcinoma of the renal pelvis: Acase reort. J, Urol. 135: 566. 1986.
33.Ramsey. J. C., Soloway. M. S.,: Instillation of bacillus Calmette-Guerin into the renal pelvis of a solitary kidney for the treatment of transitional cell carcinoma. J. Urol. 143: 1220. 1990.
, http://www.100md.com
34.Studer. U. E., Casanova. G., Kraft. R., et al: Percutaneous BGC perfusion of the upper urinary tract for carcinoma in situ. J. Urol, 142: 975. 1989.
35.Tannock. K., Gospodarowicz. M., Connolly. J., et al: MVAC(methotrexate, vinbastine, doxorubicin and cisplatin) chemotherapy for transitional cell carcinoma: The princess Margaret Hospital experience. J. Urol. 142: 28. 1989.
36.Scher. H. I., Yagoda. A., Herr. H. W., et al: Neoadjurant M-VAC for extravesical urinary tract tumor. J. Urol. 139: 475. 1988., 百拇医药
考虑使用滴注疗法来治疗上尿路上皮肿瘤，如何是一种奇闻。但Smith等[31](1987)曾报导经膀胱腔内应用丝裂霉素C来治疗伴有膀胱输尿管反流的末端输尿管肿瘤。Dekock及Brytenboch[32](1986)采用局部切除及灌注THIOTEPA到上尿路治疗上皮肿瘤，起到有益的效果，而无其他副作用。BCG也有应用于上尿路肿瘤进灌注治疗，包括原位癌(Remsey 及Soloway[33]1990，Smith等[31]1987，Studer等[34]1989)。BCG已公认取得临床效果较好的方法，但也有部分患者产生脓毒症，(Ramsey 及Soloway[33]1990，Studer[34]1989)。
灌注的途径是逆行输尿管导管或经PCN管给药。有报导曾用于孤立肾而取得较好效果，但一般认为灌注BCG反应较大，应于慎重。
, 百拇医药
放射治疗(Radiation Therapy)
上尿路上皮肿瘤的患者，放射治疗多用于手术后防止高级高期恶性病变的复发。临床实践证实，放射治疗对某些鳞状上皮细胞癌病人是有益的。放射治疗对姑息性治疗骨转移及疼痛也是常用的手段。但报导对上皮肿瘤的数目、大小、它的永久性结论尚不确切。
动脉栓塞(Angioinfarction)
动脉栓塞较少用于上尿路肾盂及输尿管癌，但常用于有症状的原发肿瘤，或伴有远处转移者。
系统化疗(Systemic Chemotherapy)
化疗抗癌药物治疗上尿路上皮肿瘤，似同治疗膀胱上皮癌。国为上尿路上皮癌较少见，目前尚无大量的报导。长期随访应用M-VAC(丝裂-长春花碱、阿霉素、卡帕)曾使之失望，仅5%有永久性疗效。41%病人可产生中性粒细胞缺乏性败血症，有2-3%因此而死亡(Tannock等[35]1989)
, 百拇医药
Scher等[36](1988)曾对一组伴有膀胱外移行上皮细胞癌的患者，应用M-VAC作为一种新的辅助治疗方法。这项研究也包括少数的上尿路移行上皮癌。其报导是不全面的，例如用于治疗膀胱癌的病人，M-VAC对混合组织肿瘤是不敏感的。同样对新的原位病灶的预防，也是不敏感的。
参考文献
1. Murphy. D. M, Zincke, H, Furlow. W. L, primary grade I transitional cell carcinoma of the renal pelvis and ureter. J. Urol. 123: 629.1980.
2. Murphy. D. M, Zincke, H, Furlow. W. L, Managgement of high grade transitional cell cancer of the upper urinary tract. J. Urol. 135: 25. 1981.
, 百拇医药
3. Anderstrom. C., Johansson. S. L, pettersson. S. et al: Carcinoma of the ureter: A cliincopathologic study of 49 cases. J. Urol. 142: 280. 1989.
4. Bloom. N. A,Vidone. R, A, Lytton. B., : primary carcinoma of the ureter: A ieport of 102 New cases. J. Urol. 103: 590 1970.
5. Mullen. J. B., Kovacs, K, primary Carcinoma of the ureteral stump: A case report and a review of the literature, J. Urol. 123: 113. 1980.
, 百拇医药
6. Mufti. G. R., Gove. J. R., Badenoch. D. F., et al: Transitional cell carcinoma of the renal prlvis and ureter. Br. J, Urol. 63: 135. 1989.
7. 杜传军，史时芳：原发性输尿管肿瘤的外科治疗。中华泌尿外科杂志。17：162，1996.
8. 栗山学:肾盂输尿管肿瘤的临床治疗变迁.日泌尿会志. 84(10): 1839. 1993(引自江恩摘,江鱼校. 国外医学. 泌尿系统分册 14: (2)96. 1994.)
9. 潘柏年,薛兆英,郭应禄等:肾盂恶性肿瘤(附161例报告).中华泌尿外科杂志15: (1) 10,1994.
10. 孔垂泽,张铭铮,刘同才等:肾盂输尿管癌术后再发尿路上皮癌中华泌尿外科杂志15: (4)263. 1994.
, 百拇医药
11. Johansson. S Wahlqvist. L.: A prognostic study of urethelial renal pelvic tumors: Comparison between the prognosis of patients treates with intrafascial nephrectomy and peritascial nephrourelerectomy. Cancer. 43: 2525. 1979.
12. Skinner. D. G,: Technipue of nephroureterectomy with regional lymph node dissection. Urol. Clin. North Am. 5: 253. 1978.
13. Babaian. R. J., Johnson. D. E.,: primary Carcinoma of the ureter. J. Urol 123: 357. 1980.
, 百拇医药
14. Batata. M. A.Whitmore. W. F., milaris. B. S., et al: Primary carcinoma of the ureter: A prognostic study. Cancer. 35: 1626. 1975.
15. Davis. B. W., Hough. A. J., Gardner. W. A., Renal pelvic carcinoma: Morphological Correlates of metastic behavior. J. Urol. 137: 857. 1987.
16.郑世广,周志耀,陈承志等:根治性切除治疗上尿路移行上皮癌.中华泌尿外科杂志. 15: (1)56. 1994.
17.Guinan. P., Renal elvic transitional cell carcinoma the role of the kidney in Tumor Node Metastasis Staging Cancer 19: 173 1992.
, 百拇医药
18.Zoretic. S., Gonzales. J.,: primary carcinoma of the ureters. Urolgy 21: 354. 1983.
19.Bazeed. M. A., Scharfe. T., Becht. E., et al: Locol excision of urethelial cancer of the upper urinary tract. Eur. Urol 12: 89. 1986.
20.Hatch. T. R., Hefty. T. R., Barry, J. H.,: Time-related recurrence rates in patents with upper tract transitional cell carcinoma. J. Urol. 140: 40. 1988.
21.Zincke. H., Neves. R. J.,: Feasibility of conservative surgery for transitional cell cancer of the upper urinary tract. Urol. Clin. North Am. 11: 717. 1984.
, http://www.100md.com
22.Ziegelbaum. M., Novick, A. C., Stteem. S. B., et al: Conservative surgery for transitional cell carcinoma of the renal pelvis. J. Urol. 138: 1146. 1987.
23.Johnson. D. E., Babaian. R. J.,: Conservative management for noninvasive distal ureteral carcinoma. Urology 13: 365. 1979.
24.Schoenbery. M. P.,: Management of transitional cell carcinoma of the solitary kidney. J. Urol. 146: 700. 1991.
, 百拇医药 25.Blute. M. L., Segura. J. W., Patterson. D. E., et al: Impact of endourology on diagnosis and management of upper urinary tract Urothilial Cancer. J. Urol. 141: 1298. 1989.
26.Schmeller. N. T., Hofstetter. A. G.,: Laser treatment of ureteral tumors. J. Urol. 141: 840. 1989.
27.Smith. A. Y., Orihuela. E., Crowley. A. R.,: Percutameous management of renal pelvic tumors: A treatment option in selected cases. J. Urol. 137: 852 1987.
, http://www.100md.com
28.Tasca. A., Zattoni, F., The case for a percutaneous approach to transitional cell carcinoma of the renal pelvis. J. Urol. 143: 902. 1990.
29.Nakada. S. Y., Calyman. R.V.,: percutoneous electro vaoriztion of upper tract transitional cell carcinoma in patients with functionally solitary kidney. Urology 46: 751.1995.
30.Patal, A, Soonawalla. P., Shepherd. S. F., et al: Longterm outcame after percutaneous treatment of transitional cell carcinoma of the renal pelvis. J Urol. 155: 868. 1996.
, 百拇医药
31.Smith. A. Y., Vitale. P. J., Lowe. B. A., et al: Treatment of superficial papillary transitional cell carcinoma of the ureter by vasicoureteral reflux of mitomycin. C. J. Urol. 138: 1231. 1987.
32.Dekock. M. L., Breytenbach. I. H.,: Locol excision and topical thiotepa in the treatment of transitional cell carcinoma of the renal pelvis: Acase reort. J, Urol. 135: 566. 1986.
33.Ramsey. J. C., Soloway. M. S.,: Instillation of bacillus Calmette-Guerin into the renal pelvis of a solitary kidney for the treatment of transitional cell carcinoma. J. Urol. 143: 1220. 1990.
, http://www.100md.com
34.Studer. U. E., Casanova. G., Kraft. R., et al: Percutaneous BGC perfusion of the upper urinary tract for carcinoma in situ. J. Urol, 142: 975. 1989.
35.Tannock. K., Gospodarowicz. M., Connolly. J., et al: MVAC(methotrexate, vinbastine, doxorubicin and cisplatin) chemotherapy for transitional cell carcinoma: The princess Margaret Hospital experience. J. Urol. 142: 28. 1989.
36.Scher. H. I., Yagoda. A., Herr. H. W., et al: Neoadjurant M-VAC for extravesical urinary tract tumor. J. Urol. 139: 475. 1988., 百拇医药