PDF(Pubmed)
Abstract：
Nephron sparing surgery (NSS) is considered for selected cases of upper tract urothelial carcinoma (UTUC) as it maintains renal function and avoids morbidity associated with radical nephroureterectomy (RNU). The appropriate selection of patients suitable for NSS without compromising oncological outcomes can sometimes be difficult, given the limitations of diagnostic modalities. Recurrence rates for UTUC can be as high as 36 to 54% after NSS. Intraluminal adjuvant therapy can be attempted following NSS to reduce recurrence, but delivery to the upper tract is more challenging than into the bladder. Bacillus Calmette-Guerin (BCG) and chemotherapy such as Mitomycin (MMC) have been administered via nephrostomy or ureteric catheter, which requires invasive/repeated instrumentation of the upper urinary tract. Drug delivery by reflux from bladder instillation along indwelling stents has also been tried but can potentially be unreliable. Recently, a gel formulation of mitomycin has been developed for the controlled exposure of the upper urinary tract to treatment over a number of hours. Drug-eluting stents to deliver chemotherapy to the upper urinary tract have been developed but have not yet entered clinical practice. Endoluminal phototherapy utilising an intravenous photosensitising agent is another novel approach that has recently been described. Intraluminal therapies may be beneficial in decreasing recurrence rates in UTUC, but currently have some limitations in their usage.
摘要：
对于上尿路尿路上皮癌（UTUC）的某些病例，考虑进行保留肾单位的手术（NSS），因为它可以维持肾功能并避免与根治性肾输尿管切除术（RNU）相关的发病率。在不影响肿瘤学结果的情况下选择适合NSS的患者有时可能很困难，鉴于诊断方式的局限性。NSS后，UTUC的复发率可高达36％至54％。NSS后可以尝试腔内辅助治疗以减少复发，但是输送到上束比输送到膀胱更具挑战性。卡介苗（BCG）和化疗如丝裂霉素（MMC）已通过肾造口术或输尿管导管进行，这需要侵入性/重复的上尿路器械。也已尝试通过膀胱滴注沿留置支架的回流进行药物递送，但可能不可靠。最近,已经开发了丝裂霉素的凝胶制剂，用于控制上尿路在数小时内的治疗。已经开发了用于将化学疗法递送到上尿路的药物洗脱支架，但尚未进入临床实践。使用静脉内光敏剂的腔内光疗是最近被描述的另一种新方法。腔内治疗可能有利于降低UTUC的复发率，但目前在使用上有一些限制。
