摘要目的：探讨内镜下激光治疗上尿路肿瘤患者的预后影响因素。方法：回顾性分析2005年2月至2014年12月期间在本院行内镜下激光治疗上尿路肿瘤的27例患者的临床及随访资料，分析影响肿瘤复发的因素。结果：随访期间19例（占70.4%）患者肾功能与术前处同一水平，14例（占51.9%）出现上尿路肿瘤复发，9例（占33.3%）出现膀胱处肿瘤复发。从诊断到局部复发的中位时间为11个月。7例（占25.9%）患者再次手术行根治性肾输尿管全切术。肿瘤的分级、大小和多灶性是影响预后的显著性因素，其中高级别肿瘤复发率高于低级别肿瘤（88.9% vs 33.3%，P＜0.05），大于1.5 cm肿瘤的复发率高于小于1.5 cm肿瘤（81.8% vs
31.3%，P＜0.05），多灶性肿瘤复发率高于单发肿瘤（87.5% vs 36.8%，P＜0.05）。输尿管肿瘤复发率为60.0%（6/10），肾盂肿瘤复发率为47.0%（8/17），有膀胱肿瘤病史者复发率为80.0%（4/5）。结论：内镜下激光治疗上尿路肿瘤的预后影响因素包括肿瘤分级、大小和多灶性。患者的依从性和随访在复发的发现上非常重要。
[1] 江郁慧, 杨国胜, 钟瑞伦. 上尿路疾病诊疗中输尿管软镜 的应用[J]. 中国医学创新, 2015, 12(3): 147-150.
[2] MUNOZ J J, ELLISON L M. Upper tract urothelial neoplasms: incidence and survival during the last 2 decades[J].J Urol, 2000, 164(5): 1523-1525.
[3] SHARIAT S F, FAVARETTO R L, GUPTA A, et al. Gender differences in radical nephroureterectomy for upper tract urothelial carcinoma[J]. World J Urol, 2011, 29(4): 481-486.
[4] COLLINS A J, FOLEY R N, CHAVERS B, et al. United States Renal Data System 2011 Annual Data Report. Atlas of chronic kidney disease and end-stage renal disease in the United States[J]. Am J Kidney Dis, 2012, 59(1 Suppl 1): A7, e1-420.
[5] HUFFMAN J L, BAGLEY D H, LYON E S, et al. Endoscopic diagnosis and treatment of upper-tract urothelial tumours. A preliminary report[J]. Cancer, 1985, 55(6): 1422-1428.
[6] KALAITZIS C, ZISIMOPOULOS A, GIANNAKOPOULOS S, et al. Ureteroscopic laser treatment of upper urinary tract urothelial cellcarcinomas: can a tumour free status be achieved?[J]. Adv Urol, 2013, 2013: 429585.
[7] BADER M J, SROKA R, GRATZKE C, et al. Laser therapy for upper urinary tract transitionall cell carcinoma: indications and management[J]. Eur Urol, 2009, 56(1): 65-71.
[8] CUTRESS M L, STEWART G D, ZAKIKHANI P, et al.Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review[J]. BJU Int, 2012, 110(5): 614-628.
[9] 成波, 韩瑞发. 影响肾盂输尿管癌预后的多因素分析[J].中华泌尿外科杂志, 2008, 29(9): 631-634.
[10] RAZDAN S, JOHANNES J, COX M, et al. Current practice patterns in urologic management of upper-tract transitional cell carcinoma[J]. J Endourol, 2005, 19(3): 366-371.
[11] NIŢĂ G, GEORGESCU D, MULŢESCU R, et, al. Prognostic factors in laser treatment of upper urinary tract urothelial tumours[J]. J Med Life, 2012, 5(1): 33-38.
[12] SUH R S, FAERBER G J, WOLF J S Jr. Predictive factors for applicability and success with endoscopic treatment of upper tract urothelial carcinoma[J]. J Urol, 2003, 170(6 Pt 1): 2209-2216.
[13] TAWFIEK E R, BAGLEY D H. Upper-tract transitional cell carcinoma[J]. Urology, 1999, 50(3): 321-329.
[14] OUZZANE A, COLIN P, XYLINAS E, et al. Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy[J]. Eur Urol, 2011, 60(6): 1258-1265.
