本文選題：尿路上皮癌　切入點(diǎn)：輸尿管鏡檢查　出處：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年04期

【摘要】：目的:分析輸尿管鏡活檢對(duì)上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)患者腫瘤級(jí)別、肌層浸潤(rùn)以及多灶性診斷的準(zhǔn)確性,分析術(shù)后腫瘤級(jí)別及肌層浸潤(rùn)的相關(guān)因素,探討輸尿管鏡活檢對(duì)UTUC患者術(shù)前危險(xiǎn)分層的可行性與必要性。方法:回顧性分析北京大學(xué)第三醫(yī)院泌尿外科2014年1月至2016年12月間輸尿管鏡活檢后行腎、輸尿管全長(zhǎng)及膀胱輸尿管口袖狀切除術(shù)患者的臨床資料。結(jié)果:患者76例,男性31例(40.8%)、女性45例(59.2%),平均年齡64.5歲(31~88歲)。腫瘤位于左側(cè)35例、右側(cè)41例,腎盂39例、輸尿管37例,癥狀為肉眼血尿者51例。術(shù)后病理提示低級(jí)別21例(27.6%)、高級(jí)別51例(67.1%),未確定級(jí)別4例(5.3%);非肌層浸潤(rùn)27例(35.5%)、肌層浸潤(rùn)47例(61.9%),無(wú)法確認(rèn)是否浸潤(rùn)2例(2.6%);術(shù)后病理均為UTUC。在50名輸尿管鏡活檢可判斷腫瘤級(jí)別的患者中,活檢病理對(duì)低級(jí)別尿路上皮癌診斷的敏感性、特異性和準(zhǔn)確性分別為88.2%、69.7%和76.0%,陽(yáng)性和陰性預(yù)測(cè)值分別為60.0%和92.0%。在27例活檢病理可以判斷是否有肌層浸潤(rùn)的患者中,5例活檢報(bào)告為肌層浸潤(rùn)的UTUC患者術(shù)后病理結(jié)果均有肌層浸潤(rùn),22例報(bào)告為非肌層浸潤(rùn)的患者術(shù)后肌層浸潤(rùn)和非肌層浸潤(rùn)各占50%,總準(zhǔn)確性為59.3%。輸尿管鏡活檢對(duì)于腫物多灶性診斷的準(zhǔn)確性為61.0%。單因素分析顯示,輸尿管鏡活檢級(jí)別與術(shù)后UTUC級(jí)別相關(guān)(P=0.001),而性別、年齡、邊側(cè)、體重指數(shù)(body mass index,BMI)、血尿、術(shù)前腎小球?yàn)V過(guò)率估計(jì)值(estimated glomerular filtration rate,e GFR)、泌尿系積水、腫瘤大小、位置、多灶性及是否有蒂均與術(shù)后UTUC級(jí)別無(wú)顯著相關(guān)性。輸尿管鏡活檢病理高級(jí)別(P=0.02)、術(shù)前e GFR90 m L/(min·1.73 m~2)(P=0.025)以及病變位于腎盂(P=0.049)與肌層浸潤(rùn)顯著相關(guān),性別、年齡、邊側(cè)、BMI、血尿、泌尿系積水、腫瘤大小、多灶性及是否有蒂與其無(wú)顯著相關(guān)性。結(jié)論:輸尿管鏡活檢可協(xié)助對(duì)UTUC患者進(jìn)行危險(xiǎn)分層。
[Abstract]:Objective: to analyze the accuracy of ureteroscopic biopsy in the diagnosis of tumor grade, myometrium infiltration and multiple foci in upper tract urothelial carcinoma of upper urinary tract, and to analyze the related factors of tumor grade and myometrium infiltration after operation. Objective: to investigate the feasibility and necessity of ureteroscopic biopsy for the risk stratification of UTUC patients before operation. Methods: ureteroscopic biopsy was performed in urology department of Peking University third Hospital from January 2014 to December 2016. Clinical data of patients with ureteral length and bladder ureteral cuff excision. Results: 76 patients, 31 males, 40.8g, 45 females, mean age 64.5 years old, 3188 years old, were located in the left side 35 cases, the right 41 cases, the renal pelvis 39 cases, the ureter 37 cases, the tumor was located in 35 cases on the left side, 41 cases on the right side, 39 cases on the renal pelvis, and 37 cases on the ureter. The symptoms were gross hematuria in 51 cases. The pathological findings showed that 21 cases had low grade (27.661), 51 cases had high grade (67.1%), 4 cases had undetermined grade (5.3%), 27 cases had non-myometrium infiltration (35.5m), 47 cases had muscular infiltration (47 cases), it could not be confirmed whether it was infiltrating in 2 cases (2.6%), and the postoperative pathology was UTUC. Of the 50 patients with ureteroscopic biopsies who were able to determine tumor grade, Sensitivity of biopsy pathology to the diagnosis of low grade urothelial carcinoma. The specificity and accuracy were 88.2% and 76.0%, respectively. The positive and negative predictive values were 60.0% and 92.0%, respectively. In 27 patients with myometrium infiltration, 5 out of 27 patients with myometrium infiltration could be judged by biopsy. The total accuracy of myometrium infiltration and non-myometrium infiltration were 59.3% respectively. The accuracy of ureteroscopic biopsy for the diagnosis of multifocal tumor was 61.0%. Ureteroscopic biopsy grade was correlated with postoperative UTUC grade. Sex, age, side side, body mass index (BMI) mass BMIA, hematuria, estimate of preoperative glomerular filtration rate (GFR), urinary hydronephrosis, tumor size, location, etc. There was no significant correlation between multi-focus and pedicle and postoperative UTUC grade. Ureteroscopic biopsy with high grade P0. 02, preoperative e GFR90 m L/(min 1. 73 mP0. 025) and lesion located in renal pelvis P0. 049) were significantly correlated with myometrium infiltration, sex, age, side side, hematuria, sex, age, side of ureteroscopic biopsy, and hematuria. There was no significant correlation between urological hydronephrosis, tumor size, multi-focus and pedicle. Conclusion: ureteroscopic biopsy can assist in the risk stratification of UTUC patients.
【作者單位】： 北京大學(xué)第三醫(yī)院泌尿外科;北京大學(xué)第三醫(yī)院病理科;
【分類號(hào)】：R737.1

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