孔垂泽 慈健 刘同才 张铭铮 张维国 杨涛 李书章 李芳 孙志熙 李泽良 110001 沈阳，中国医科大学第一临床学院泌尿外科(孔垂泽、慈健、刘同才、张铭铮、杨涛、李书章、李芳、孙志熙、李泽良)；沈阳市第五人民医院泌尿外科(张维国) 中华肿瘤杂志 1998 11 0 6


    关键词：输尿管肿瘤/外科学；尿路上皮癌；膀胱肿瘤 期刊 zhzlzz 0 临床研究 fur -->


    

【摘要】 目的 为防治输尿管癌术后再发尿路上皮癌，对其再发因素及特点进行探讨。方法采用回顾性研究对35例输尿管癌进行随访总结。结果 肾输尿管膀胱部分切除的32例中，再发膀胱癌16例，占50.0%。同时发生尿路上皮多器官癌14例，再发膀胱癌10例，占71.4%；输尿管单处癌18例，再发膀胱癌6例，占33.3%，其中5例为输尿管下段癌术后再发。细胞分级：G₁ 级4例，无一例再发；G₂ ～G₃ 级28例，再发膀胱癌16例，占57.1%。分期：T₁ 期6例，2年内再发膀胱癌1例；T₂ ～T₃ 期26例，2年内再发膀胱癌10例，2年后再发5例均为Ⅰ～Ⅱ期。3例肿瘤局部切除术后再发上尿路癌2例。再发时间为术后3个月～6.5年(平均1.86年)。16例术后再发尿路上皮癌生存超过3年者3例，8例非再发尿路上皮癌生存超过3年者6例。结论 输尿管下段癌同时发生尿路上皮多器官癌和肿瘤细胞分化不良、分期高的浸润性肿瘤术后膀胱癌再发率高，术后应定期做膀胱镜检查。再发尿路上皮癌生存率低，预后不良。

Recurrent urothelial cancer afterresection of ureteral carcinoma Kong Chuize, Ci Jian, Liu Tongcai, et al. Department of Urology, The First Affiliated Hospital,China Medical University, Shenyang 110001

     【Abstract】 Objective To preventand treat recurrent urothelial cancer after resection of ureteral carcinoma, recurrence-associated factors and their features were analyzed. Methods Thirty five cases of ureteral cancer were studied retrospectively.Results There were 16 cases of recurrentbladder cancer among 32 cases after kidney-ureter and partial bladder removal. Bladdercancer recurred in 10 of 14 cases (71.4%) with multi-organ urothelial cancers. Six out of18 cases with single ureteral cancer had recurrent cancer in the bladder. In 5 of the 6cases, the primary tumor was located at the lower ureter. None of the 4 cases in grade Ⅰhad tumor recurrence while there were 16 cases of recurrentbladder cancer in 28 cases in grade Ⅱ-Ⅲ. There was one recurrent bladder cancer in 6 cases in stage T₁ within 2 years after operation. Among 26 cases in stage T₂ -T₃ , 10cases of recurrent bladder cancer occurred in 2 years. After 2 years, 5 recurrent caseswere in stage T₁ -T₂ . There were 2 recurrent urothelial carcinomas in3 cases whose tumors were removed by local resection. The time of recurrence was 3 monthsto 6.5 years (average 1.86 years). Of 16 cases with recurrent urothelial cancer, 3 werealive for more than 3 years after operation. Of 8 cases without recurrence 6 survived formore than 3 years. Conclusion Recurrenturothelial cancer after resection of ureteral cancer occurs more frequently when theneoplasm is located in the lower ureter, involving more than one organ, with high-gradecell differentiation and high invasiveness. Prognosis of recurrent urothelial cancer ispoor. Regular cystoscopic check-up is helpful to find the recurrence.

     【Subject words】 Ureteral neoplasms/surgery Urothelialcarcinoma Bladder neoplasms

早在1975年Wallace就提出了“全尿路上皮肿瘤”的概念 ......