膀胱肿瘤后发生的肾盂和输尿管肿瘤(附2例报告)
作者：张文鼎 唐涌志 汤海 肖军
单位：200040 上海市静安区中心医院泌尿外科
关键词：
中国煤炭工业医学杂志000920 尿路肿瘤的特点是其多源性，复发的尿路肿瘤可以在原来的位置，也可以发生在整个尿路的任何部位。50%以上的浅表性膀胱肿瘤(Ta及T1)会复发[1]，Oldbring综合文献约40%(18%-57%)的上尿路肿瘤同时或在其前后发生膀胱肿瘤[2]。但在膀胱肿瘤之后发生的上尿路肿瘤所占比例较小[3.4]，文献报道浅表性膀胱肿瘤其发生率为2%-4%，膀胱全切术后的发生率1%-9%[5]。Holmang等报道在他们一组患者680例，随访至少5年，有16例发生肾盂和输尿管肿瘤，发生率为2.4%，每年的发生率是0.5%[4]。Oldbring认为他们统计的数据比较可靠(1.7%)，因为他们所在的城市有91%的尸体得到解剖，他们所统计的11例(11/657)患者有5例是在尸解时发现的[2]。国内文献报道尚不多，我院近年收治2例膀胱肿瘤后发生的上尿路肿瘤，现报告如下，并结合文献复习，加以讨论。
, 百拇医药
1 病例报告
例1，患者，男72岁。患者1992年因无痛性血尿，在我院行膀胱镜检查发现右侧输尿管开口内上侧有一约2.5cm×2.5cm×2.5cm大小菜花样肿瘤，收入院。入院后检查：尿细胞学示(一)，B超及IVP皆示膀胱内占位，上尿路未见异常，择期行耻骨上膀胱肿瘤切除术，术后病理示：移行细胞癌Ⅱ级，局限于粘膜内。患者出院后定期行小剂量(2mg)BCG腔内灌注治疗。全文见PDF……
参考文献：
[1]Holmang, S, Hedelin, H, Anderstrom, C, Holmberg, E. And Johansson,S. L. The relationship among multiple recurrnces ,progression and prognosis of patients with stags TA and T1 transitional cell cancer of the bladder followed for at least 20 years. J. Urol, 1995,153:1823-1826.
, 百拇医药
[2]Oldbring ,J,Glifberg, I,Mikulowski, P. And Hellsten, S. Carcinoma of the renal pelvis and ureter following bladder carcinoma: risk factors and clinicopathological findings. J. Urol, 1989,141,1311-1313.
[3]Holmang, S, Hedelin, H, Anderstrom, C, Holmberg, E. And Johansson,S. L:Long-term followup of a bladder carcinoma cohort: routine followup urography is not necessary. J. Urol,1998,160(1) :45-48.
[4]Kenworthy,P,Tanguay,S. And Dinney,N. P. C:The risk of upper tract recurrence following cystectomy in patients with transitional cell carcinoma involving the distal ureter. J. Uro1,1996,155:501-503.
, http://www.100md.com
[5]Amar,A. D. And Das,S: Upper urinary tract transitional cell carcinoma in patients with bladder carcinoma and associated vesicoureteral reflux. J. Urol, 1985,133: 468-471.
[6]Walzer, Y. And Soloway, M. S: should the follow-up of patients with bladder cancer include routine excretory urography? J.Urol, 1983,130,672-673.
[7]Hastie, J. K, Hamdy, C. F. Collins, C. M. And Williams. L. J:Upper tract tumours following cystectomy for bladder cancer. Is routine intravenous urography worthwhile? Bri. J. Urol,1991,67:29-31.
, http://www.100md.com
[8]Herr,H. W,Cookson,M. S. And Soloway,S. M: Upper tract tumors in patients with primary bladder cancer floolwed for 15 years. J. Urol, 1996,156:1286-1287.
[9]Miler, E. B, Eure, G. R. And Schellbammer, P. F, Upper tract transitional cell carcinoma following treatment of superficial bladder cancer with BCG. Urology, 1993.42 (1), 26-30.
收稿日期：2000-05-22
修稿日期：2000-07-07, http://www.100md.com
单位：200040 上海市静安区中心医院泌尿外科
关键词：
中国煤炭工业医学杂志000920 尿路肿瘤的特点是其多源性，复发的尿路肿瘤可以在原来的位置，也可以发生在整个尿路的任何部位。50%以上的浅表性膀胱肿瘤(Ta及T1)会复发[1]，Oldbring综合文献约40%(18%-57%)的上尿路肿瘤同时或在其前后发生膀胱肿瘤[2]。但在膀胱肿瘤之后发生的上尿路肿瘤所占比例较小[3.4]，文献报道浅表性膀胱肿瘤其发生率为2%-4%，膀胱全切术后的发生率1%-9%[5]。Holmang等报道在他们一组患者680例，随访至少5年，有16例发生肾盂和输尿管肿瘤，发生率为2.4%，每年的发生率是0.5%[4]。Oldbring认为他们统计的数据比较可靠(1.7%)，因为他们所在的城市有91%的尸体得到解剖，他们所统计的11例(11/657)患者有5例是在尸解时发现的[2]。国内文献报道尚不多，我院近年收治2例膀胱肿瘤后发生的上尿路肿瘤，现报告如下，并结合文献复习，加以讨论。
, 百拇医药
1 病例报告
例1，患者，男72岁。患者1992年因无痛性血尿，在我院行膀胱镜检查发现右侧输尿管开口内上侧有一约2.5cm×2.5cm×2.5cm大小菜花样肿瘤，收入院。入院后检查：尿细胞学示(一)，B超及IVP皆示膀胱内占位，上尿路未见异常，择期行耻骨上膀胱肿瘤切除术，术后病理示：移行细胞癌Ⅱ级，局限于粘膜内。患者出院后定期行小剂量(2mg)BCG腔内灌注治疗。全文见PDF……
参考文献：
[1]Holmang, S, Hedelin, H, Anderstrom, C, Holmberg, E. And Johansson,S. L. The relationship among multiple recurrnces ,progression and prognosis of patients with stags TA and T1 transitional cell cancer of the bladder followed for at least 20 years. J. Urol, 1995,153:1823-1826.
, 百拇医药
[2]Oldbring ,J,Glifberg, I,Mikulowski, P. And Hellsten, S. Carcinoma of the renal pelvis and ureter following bladder carcinoma: risk factors and clinicopathological findings. J. Urol, 1989,141,1311-1313.
[3]Holmang, S, Hedelin, H, Anderstrom, C, Holmberg, E. And Johansson,S. L:Long-term followup of a bladder carcinoma cohort: routine followup urography is not necessary. J. Urol,1998,160(1) :45-48.
[4]Kenworthy,P,Tanguay,S. And Dinney,N. P. C:The risk of upper tract recurrence following cystectomy in patients with transitional cell carcinoma involving the distal ureter. J. Uro1,1996,155:501-503.
, http://www.100md.com
[5]Amar,A. D. And Das,S: Upper urinary tract transitional cell carcinoma in patients with bladder carcinoma and associated vesicoureteral reflux. J. Urol, 1985,133: 468-471.
[6]Walzer, Y. And Soloway, M. S: should the follow-up of patients with bladder cancer include routine excretory urography? J.Urol, 1983,130,672-673.
[7]Hastie, J. K, Hamdy, C. F. Collins, C. M. And Williams. L. J:Upper tract tumours following cystectomy for bladder cancer. Is routine intravenous urography worthwhile? Bri. J. Urol,1991,67:29-31.
, http://www.100md.com
[8]Herr,H. W,Cookson,M. S. And Soloway,S. M: Upper tract tumors in patients with primary bladder cancer floolwed for 15 years. J. Urol, 1996,156:1286-1287.
[9]Miler, E. B, Eure, G. R. And Schellbammer, P. F, Upper tract transitional cell carcinoma following treatment of superficial bladder cancer with BCG. Urology, 1993.42 (1), 26-30.
收稿日期：2000-05-22
修稿日期：2000-07-07, http://www.100md.com
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