Urothelial Tumors of the Upper Urinary Tract Following Transurethral Resection of Bladder Transitional Cell Carcinoma:Mackay Memorial Hospital Experience炯

膀胱移形性上皮癌經尿道切除後在上泌尿道癌之發生：馬偕醫院的經驗

許炯明(Jong-Ming Hsu) ； 羅景易(King-Yik Lo) ； 林文州(Wen-Chou Lin) ； 張奐光(Huang-Kuang Chang) ； 周固(Ku Chou) ； 楊志東(Stone Yang)

《中華民國泌尿科醫學會雜誌》 12卷1期 (2001/03) Pp. 32-37

https://doi.org/10.7024/JUAROC.200103.0032

摘要

目的：尿路移形性上皮癌主要特徵就在初次診斷時常已是多發性的。而最初的腫瘤治療以後還有可能在尿路任何一部位產生後續腫瘤。本研究的目的乃是找出經尿道膀胱腫瘤切除後續發上泌尿道腫瘤之機率及危險因子。同時我們也試著找出膀胱腫瘤術後對上泌尿道的一個合理追蹤方法。
材料及方法：馬偕醫院回顧1988年1月至1993年12月之間共150位患者在本院接受經尿道膀胱腫瘤切除術。每位患者術後繼續追蹤5年以上或直到死亡為止。追蹤方法包含膀胱鏡，靜脈內尿路攝影或腎臟超音波及尿路細胞學檢查。所有病患特徵及可能的危險因子均詳細記錄並予統計比較。
結果：150位患者有5位在平均24.2個月後發現有上泌尿道癌之發生。同時我們發現若是原來膀胱腫瘤為高度惡性化或是合併有原位癌或為多發性腫瘤，則有較高比例的患者在經尿道膀胱腫瘤切除後繼發上泌尿道癌。
結論：高危險群患者術後應以靜脈內尿路攝影檢查持續三年以上，期能及早發現繼發上泌尿道癌的情形。之後可用腎臟超音波來取代靜脈內尿路攝影。而當患者在檢查及症狀上懷疑有上泌尿道癌時，就必須施行輸尿管鏡檢配合腫瘤切片或選擇性上泌尿道細胞學檢查來確立繼發上泌尿道癌的診斷。

關鍵字

經尿道切除 ； 移形性上皮癌 ； 上泌尿道

並列摘要

OBJECTIVE: Urothelial carcinoma is characterized by a tendency for multifocal locations at the initial diagnosis and subsequent tumors after treatment of the initial tumors occurring anywhere within the entire urinary tract. The aim of this study was to determine the incidence and risk factors of upper urinary tract tumor occurrence following TURBT. We also determine a reasonable follow-up scheme for postoperative monitoring.
MATERIALS AND METHODS: From January 1988 to December 1993, 150 patients who underwent a transurethral resection of primary bladder transitional cell carcinoma were re-viewed at our hospital. Each patient was followed for at least 5 years or until death. Follow-up tests included cystoscopy, intravenous pyelography or sonography, and urine cytology. To analyze the risk factors for upper urinary tract tumor occurrence, the Kaplan-Meier method was performed.
RESULTS: Subsequent upper tract tumor development was found in 5 of 150(3.3%) patients at an interval of 9 to 46 months(mean, 24.2 months).Patients with a primary bladder tumor of high tumor grade, associated with a carcinoma in situ or a multifocal tumor, are at in-creased risk for subsequent upper tract tumor development.
CONCLUSIONS: High-risk patients must be minitored with IVP yearly for at least 3 years for early detection of upper tract tumors, and thereafter IVP can be replaced by renal sonography. Once a patient presents with a sign or symptom suggesting upper tract TCC, IVP, ureteroscopy with biopsy, or selective upper tract urinary cytology must be performed to help establish a diagnosis.

並列關鍵字

transurethral resection ； transitional cell carcinoma ； upper urinary tract