Department of Urology, Peking Union Medical College Hospital, Beijing, China.
Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuai Fu Yuan 1, Wang Fu Jing Street, Beijing, 100730, China.
BMC Cancer. 2018 Feb 17;18(1):196. doi: 10.1186/s12885-018-4118-y.
Treatment with the combination of ureteroscopy and thulium laser ablation may provide an alternative to radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC). The purpose of this study was to investigate the efficacy and safety of this technique.
We performed a retrospective review of the data for patients who were treated surgically for upper tract urothelial carcinoma in a single center. It included 32 patients treated by endoscopic thulium laser resection and 107 patients treated by radical nephroureterectomy (RNU). We compared the data of patient sex, age at diagnosis, location of carcinoma, length of hospitalization, tumor site, size, grade, recurrence, preoperative creatinine and postoperative creatinine in two groups. Patients were examined by ureteroscopy every 3 months during the first year after surgery, then every 6 months each year.
All 32 patients were treated successfully, among which 6 were operated by a flexible ureteroscope. The average tumor size was 13 ± 7 mm in diameter. The tumor was rated as low grade in 27 patients and high grade in 5 patients. Ureteral stricture developed in 4 patients 3 months later after surgery, but the stricture was succesfully treated through endoscopic dilation. Seven patients had tumor recurrence, 3 of which underwent nephroureterectomy during the follow-up. Postoperative creatinine levels (umol/L) were respectively 89 ± 7.5 in laser group and 123 ± 15.4 in RNU group (p < 0.01). Length of hospitalization was respectively 3.6 ± 1.9 and 8.6 ± 2.4 days (p < 0.01). Local or bladder recurrence rate of thulium laser group and RNU group was respectively 21.9 and 13.1% (p < 0.01).
Thulium laser group is associated with a less loss of renal function, a shorter length of hospitalization, but a higher rate of tumor recurrence. Thulium laser therapy combined with ureteroscopic treatment can be considered as an acceptable treatment for selected cases of UTUC. Lifetime intensive surveillance is necessary.
输尿管镜联合钬激光碎石术治疗上尿路尿路上皮癌（UTUC）可作为根治性肾输尿管切除术（RNU）的替代方法。本研究旨在探讨该技术的疗效和安全性。
我们对单中心接受手术治疗的上尿路尿路上皮癌患者进行了回顾性分析。其中 32 例患者采用内镜钬激光切除术治疗，107 例患者采用根治性肾输尿管切除术（RNU）治疗。我们比较了两组患者的性别、诊断时年龄、癌灶位置、住院时间、肿瘤部位、大小、分级、复发、术前和术后血肌酐等资料。术后患者在第 1 年每 3 个月行输尿管镜检查，此后每年检查 6 个月。
32 例患者均手术成功，其中 6 例采用软性输尿管镜治疗。肿瘤平均直径为 13±7mm。27 例肿瘤分级为低级别，5 例为高级别。术后 3 个月，4 例患者出现输尿管狭窄，经内镜扩张治疗后成功。7 例患者肿瘤复发，其中 3 例在随访期间行肾输尿管切除术。钬激光组和 RNU 组患者术后血肌酐水平（μmol/L）分别为 89±7.5 和 123±15.4（p<0.01）。住院时间分别为 3.6±1.9 和 8.6±2.4 天（p<0.01）。钬激光组和 RNU 组患者的局部或膀胱复发率分别为 21.9%和 13.1%（p<0.01）。
钬激光组患者肾功能丧失更少，住院时间更短，但肿瘤复发率更高。钬激光联合输尿管镜治疗可作为治疗 UTUC 的一种可接受的方法，需要终生密切监测。
