Kim Young-Joo, Jeon Seung Hyun, Huh Jung-Sik, Chang Sung-Goo
College of Medicine, Cheju National University, Jeju, Republic of Korea.
Eur Urol. 2004 Dec;46(6):748-52. doi: 10.1016/j.eururo.2004.07.005.
The occurrence of primary carcinoma of the ureteral stump after nephrectomy is rare. In this study, we evaluated the clinical characteristics of ureteral stump tumors after nephrectomy for benign renal disease.
During a 16-year period, 318 consecutive patients underwent simple nephrectomy for benign renal disease (216 cases) or for donation (102 cases). Eight of these 318 patients diagnosed as having an ureteral stump tumor were treated by ipsilateral ureterectomy with cuff excision of the bladder. Pathologic findings, tumor stages, and clinical characteristics were analyzed.
The eight ureteral stump tumors comprised; 6 transitional cell carcinomas (TCCs) and 2 squamous cell carcinomas (SCCs). The mean interval between nephrectomy and ureteral stump tumor diagnosis was 76.5 months. Six of the 8 patients had pyonephrosis and two renal tuberculosis as original renal diseases. Four of the 6 TCCs were stage T1 and 2 stage T2. There was no concomitant bladder tumor at stump tumor diagnosis. Hematuria was the major presenting symptom in 3 of the 8 patients and 4 patients were diagnosed by follow-up imaging study. Two of the 6 ureteral stump TCC patients developed bladder TCC during follow-up. The 5-year survival rate of patients with ureteral stump tumor was 37.5%. T1G1 TCC was associated with a better survival than T2 or G2 TCC. No ureteral stump tumor occurred in cases of donor nephrectomy.
This study demonstrate, that long-term closed observation is needed to detect ureteral stump tumor, particularly in patients that have undergo nephrectomy for a long-standing inflammatory renal disease such as pyonephrosis or tuberculosis. Hematuria is a major presenting symptom of ureteral stump tumor. However, a follow-up imaging study is also important for ureteral stump tumor detection. The prognosis is poor in cases developing ureteral stump SCC, bladder tumor recurrence, or a high-grade ureteral tumor.
肾切除术后输尿管残端原发性癌的发生较为罕见。在本研究中，我们评估了因良性肾脏疾病行肾切除术后输尿管残端肿瘤的临床特征。
在16年期间，318例连续患者因良性肾脏疾病（216例）或供肾（102例）接受了单纯肾切除术。这318例患者中有8例被诊断为输尿管残端肿瘤，接受了患侧输尿管切除术并膀胱袖口状切除术。分析了病理结果、肿瘤分期和临床特征。
8例输尿管残端肿瘤包括：6例移行细胞癌（TCC）和2例鳞状细胞癌（SCC）。肾切除术后至输尿管残端肿瘤诊断的平均间隔时间为76.5个月。8例患者中有6例原发病为肾盂积脓，2例为肾结核。6例TCC中4例为T1期，2例为T2期。在残端肿瘤诊断时无合并膀胱肿瘤。血尿是8例患者中3例的主要表现症状，4例通过随访影像学检查确诊。6例输尿管残端TCC患者中有2例在随访期间发生膀胱TCC。输尿管残端肿瘤患者的5年生存率为37.5%。T1G1 TCC的生存率优于T2或G2 TCC。供肾肾切除病例未发生输尿管残端肿瘤。
本研究表明，需要长期密切观察以检测输尿管残端肿瘤，特别是对于因肾盂积脓或结核等长期炎性肾脏疾病接受肾切除术的患者。血尿是输尿管残端肿瘤的主要表现症状。然而，随访影像学检查对于输尿管残端肿瘤的检测也很重要。发生输尿管残端SCC、膀胱肿瘤复发或高级别输尿管肿瘤的病例预后较差。
