上尿路结石合并肾盂癌的诊治(附6例报告)  

Diagnosis and treatment of upper urinary tract calculi complicated with carcinoma of renal pelvis(Report of 6 cases)

作　　者：金纪忠[1] 丁滔[1,2] 韩跃辅[2] 许小林[1] 刘峰[1] 刘林涛[1] 俞建军[1,3] 

机构地区：[1]上海交通大学附属第六人民医院南院泌尿外科,上海201489 [2]汕头大学医学院附属粤北人民医院泌尿外科 [3]上海交通大学附属第六人民医院泌尿外科

出　　处：《临床泌尿外科杂志》2017年第7期554-556,共3页Journal of Clinical Urology

摘　　要：目的:提高上尿路结石合并肾盂癌的诊断和治疗水平。方法:回顾性分析上海市第六人民医院南院及广东省粤北人民医院2009年1月~2015年12月期间6例上尿路结石合并肾盂癌患者的临床资料及诊治经过。结果:6例患者中,1例术前CT提示肾盂癌,另外5例术前B超、IVU、CT扫描均未发现肾盂癌,3例经皮肾镜取石术(PCNL)中发现肾盂肿物取活检病理证实为肾盂癌,1例肾切除术后病理证实为肾盂癌,1例PCNL术后沿穿刺通道广泛转移CT扫描考虑为肾盂癌。6例患者中,肾盂癌根治术5例,1例PCNL术后肿瘤广泛转移失去手术机会,患者放弃治疗、失访;行手术5例患者术后3例患者未见肿瘤进展,2例在术后3个月内出现肿瘤复发、转移,术后6个月内死亡。结论:上尿路结石病史长、年龄较大、合并肾积水及感染的患者,应考虑合并肾盂癌的可能;明确上尿路结石合并肾盂癌的诊断后,应放弃对结石的治疗,尽快行肾盂癌根治术。Objective：To investigate the diagnosis and treatment of upper urinary tract calculi associated with renal pelvic carcinoma.Method：A retrospective analysis of clinical data of six cases with upper urinary tract calculi associated with renal pelvic carcinoma had been conducted.Result：The diagnosis was confirmed in one patient with preoperative CT scan.The remaining were diagnosed intraoperatively or postoperatively.Three cases were diagnosed as having pelvic tumor when they were performed PCNL,and one was confirmed by pathology after nephrectomy.The rest one with tumor metastasis after PCNL received CT scan,and was found renal pelvic carcinoma.Five cases were performed radical nephroureterectomy and intravesical instillation,but one case gave up treatment because of tumor distant metastasis.No recurrence or metastasis was noted in three cases during follow-up period.Two cases died of renal pelvic carcinoma metastasis six months after surgery.Conclusion：Although the preoperative diagnosis of upper urinary tract calculi associated with renal pelvic carcinoma is difficult,renal pelvic carcinoma should be considered before surgery in the patients with long history of upper urinary tract calculi,aged,hydronephrosis and infection.When upper urinary tract calculi associated with renal pelvic carcinoma are confirmed,we should give up treating the upper urinary tract calculi and perform radical nephroureterectomy as soon as possible.

关 键 词：肾盂癌 上尿路结石 经皮肾镜取石术 诊断 治疗 

分 类 号：R737.11[医药卫生—肿瘤] R693[医药卫生—临床医学]