肾结石合并肾盂癌的诊断和治疗  

Renal pelvic carcinoma associated with renal stone

作　　者：雷鸣[1] 袁坚[1] 刘永达[1] 张泽[1] 罗金泰[1] 朱玮[1] 

机构地区：[1]广州医学院第一附属医院微创外科中心泌尿外科广东省泌尿外科重点实验室,510230

出　　处：《中华泌尿外科杂志》2013年第7期485-488,共4页Chinese Journal of Urology

摘　　要：目的 提高对肾结石合并肾盂癌的诊治水平. 方法 2008年6月至2012年10月收治的肾结石合并肾盂癌患者13例,男8例,女5例.年龄49～73岁,平均59岁.肾结石病史平均16年.患者均行B超检查,仅1例发现肾脏软组织占位病变.IVU检查8例,未发现肾脏软组织占位病变.CT检查7例,发现肾脏软组织占位4例.尿液多色荧光原位杂交探针检查2例,均为阳性.6例经皮肾镜取石术（PCNL）中发现肾盂黏膜病变,依据活检病理结果,4例行肾盂癌根治术,2例行根治性肾切除术.2例PCNL术后仍反复肉眼血尿,经输尿管软镜检查及活检确诊为肾盂尿路上皮癌,行肾盂癌根治术.4例术前CT检查发现肾脏软组织占位者均行肾盂癌根治术.1例肉眼血尿患者因高龄并肾功能不全,行经尿道输尿管镜下肾盂肿瘤钬激光汽化术. 结果 13例患者术后病理诊断为肾盂尿路上皮癌7例,尿路上皮癌并鳞状细胞癌化生4例,鳞状细胞癌2例.8例行PCNL者术后结石成分分析结果为感染性结石6例,混合性含钙结石2例.3例尿路上皮癌患者术后随访1～2年,未发现肿瘤复发；1例腔内肾盂肿瘤汽化术患者,术后10个月肿瘤复发,再次行腔内肿瘤汽化术；1例鳞癌并局部淋巴结转移者术后13个月因肿瘤转移死亡. 结论年龄较大、结石病史长、合并感染且严重血尿或取石后仍血尿的患者,应考虑合并肾盂癌的可能.CT与尿液多色荧光原位杂交探针检查对诊断肾结石合并肾盂癌有一定价值.腔内结石手术中对可疑肾盂黏膜病变应常规活检.早期诊断和手术是治疗肾结石合并肾盂癌的关键.Objective To discuss the diagnosis and treatment of renal pelvic carcinoma associat- ed with renal stone. Methods A total of 13 patients, aged from 49 to 73 years old and averaged 59 years old. The history of renal stone was 16 years. 13 patients accepted B ultrasound check and 1 was found soft tissue occupying. 8 patients accepted IVU check and none was found soft tissue occupying. 7 patients accepted CT scan and 4 were found soft tissue occupying. The fluorescence in situ hybridiza- tion （FISH） examination was done for 2 patients and both were positive. 6 patients were found lesions at renal pelvis mucous membrane during the operation of percutaneous nephrolithotripsy, 4 accepted radical operations of renal pelvic carcinoma and 2 patients accepted radical nephrectomy according to the biopsy pathology. 4 were found soft tissue occupying before operation and accepted radical opera- tion of renal pelvic carcinoma ultimately. 1 patient suffered gross hematuria and renal insufficiency ac- cepted the renal pelvic carcinoma vaporization under the ureteroscope. Results The pathology showed that 7 cases were transitional cell carcinoma, 4 were transitional cell carcinoma combined squamous cell carcinoma （SCC） metaplasia and 2 were squamous cell carcinoma. 6 of 8 patients＇ stone chemical composition were infection stone and 2 were calcic blended stone. 3 patients were followed up I to 2 years and survival with no tumor recurrence. The tumor recurred 10 months of the patient ac-cepted the operation of renal pelvic carcinoma vaporization and accepted vaporization again. 1 patient suffered SCC and local lymph node metastasis. He died 13 months post-operation. Conclusions For the patient who had long history o{ stone, combining in{ection with symptoms o{ severe hematuria and postoperation hematuria, the possibility o{ renal pelvic carcinoma should be considered. CT scan and urine FISH may help for diagnosis. The biopsy should routinely perform for the doubtful mucosa le- sion during the cavity stone operation. Earl

关 键 词：肾盂癌 肾结石 诊断 治疗 

分 类 号：R692.4[医药卫生—泌尿科学] R737.11[医药卫生—外科学]