肾结石合并肾盂癌的诊断和治疗  

Diagnosis and treatment of renal calculus associated with carcinoma of renal pelvis

作　　者：仲浩舟 谢汶桂 黄玉华[1] 欧阳骏[1] 浦金贤[1] 侯建全[1] 席启林[1] ZHONG Haozhou;XIE Wengui;HUANG Yuhua;OUYANG Jun;PU Jinxian;HOU Jianquan;XI Qilin(Department of Urology,First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院泌尿外科,215006

出　　处：《现代泌尿生殖肿瘤杂志》2020年第6期328-330,共3页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的提高对肾结石合并肾盂癌的诊治水平。方法回顾性分析2010年12月至2020年5月苏州大学附属第一医院泌尿外科收治的23例病理检查确诊为肾结石合并肾盂肿瘤的患者资料。男16例,女7例,中位年龄61岁,临床表现为血尿16例,腰痛9例。23例患者均常规行泌尿系B超或尿路平片检查,术前诊断为肾结石合并肾盂肿瘤的21例患者均行全腹增强CT或MR检查,术前诊断为肾结石的2例患者仅行平扫CT,其中输尿管镜术中诊断为肾盂肿瘤1例,术后因经皮肾伤口肿块行肿块切除病理确诊1例。9例患者术前均行尿细胞学检查,见可疑肿瘤细胞4例。23例患者均行手术治疗,其中15例行诊断性输尿管镜检查。结果病理诊断为鳞状细胞癌2例,尿路上皮癌伴鳞状分化1例,胚胎性横纹肌肉瘤1例,黏液腺癌1例,尿路上皮癌16例,尿路上皮癌合并伤口种植2例。术后16例患者行放化疗或免疫治疗。中位随访时间50(1~104)个月。4例膀胱内肿瘤复发,6例死亡,其中5例死于肿瘤进展,1例死于心脏疾患。结论对于肾结石病史长、既往有多次肾结石手术史、结石负荷大、合并上尿路梗阻和感染、严重血尿的患者,应考虑合并肾盂癌可能,应完善尿细胞学检查及尿液肿瘤标记物检测,完善肾脏增强CT或MR检查。术中发现合并肾盂肿瘤,应一期行根治性肾输尿管切除术。术后发现合并肾盂肿瘤者,应尽早行挽救性综合治疗。Objective To improve the diagnosis and treatment of renal calculus associated with renal pelvis carcinoma.Methods The data of 23 patients with renal calculus associated with renal pelvis tumor diagnosed by pathological examination in First Affiliated Hospital of Soochow University from December 2010 to May 2020 were analyzed retrospectively.There were 16 males and 7 females.Their median age was 61 years old.The clinical manifestations included hematuria(n=16)and low back pain(n=9).All the 23 cases were routinely examined by B-ultrasound or plain radiography.Enhanced CT or magnetic resonance imaging were acquired for 21 cases of renal calculus associated with renal pelvic tumors.Two cases of renal calculus only underwent plain scan CT preoperatively,of which 1 case was diagnosed as renal pelvis tumor during ureteroscopy and 1 case was confirmed as renal pelvis tumor by surgical resection of wound mass after percutaneous nephrolithotomy.Urine cytology was performed in 9 cases,and suspicious tumor cells were found in 4 cases.All 23 cases obtained operative treatment,of which 15 cases underwent diagnostic ureteroscopy.Results There were 2 cases of squamous cell carcinoma,1 case of urothelial carcinoma with squamous differentiation,1 case of embryonal rhabdomyosarcoma,1 case of mucinous adenocarcinoma,16 cases of urothelial carcinoma and 2 cases of urothelial carcinoma with wound implantation.Radiotherapy,chemotherapy or immunotherapy were performed in 16 cases.During a median follow-up period of 50(1-104)months,4 experienced bladder tumour recurrence and 6 died,of which 5 died of tumor progression and 1 died of heart disease.Conclusions Renal pelvis tumor should be considered for patients with long history of renal calculus,previous renal stone operations,large-sized stone,upper urinary tract obstruction and severe hematuria.Urine cytology and urine tumor markers should be examined,and renal enhanced CT or magnetic resonance imaging should be performed.If renal pelvis tumor is found during operation,one-stage radical

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]