多器官尿路上皮癌误诊分析并文献复习

目的探讨多器官尿路上皮癌的误诊原因及预防措施。 方法回顾分析2006年2月至2012年10月收治被误诊误治的3例多器官尿路上皮癌患者临床资料。 结果3例均为男性,年龄分别为83岁、69岁和71岁,均以血尿待查住院。例1、例2首次均以膀胱移行细胞癌在外院多次行经尿道膀胱肿瘤切除术(TURBt),例1于3个月前,曾在外院先后行腹腔镜下膀胱癌根治术和肾切除术、回肠膀胱术;例2在入院前,曾在外院行肾输尿管部分切除;例3以肾盂癌在外院行肾、输尿管部分切除术。患者入院后行尿细胞学检查和B超、静脉肾盂造影(IVP)、CT尿路造影(CTU)或磁共振(MRI)检查及膀胱镜检查。例1诊断为复发性膀胱癌术后,肾切除术后右输尿管残段癌,左肾积水,肾功能不全,全身多发性转移;例2为复发性膀胱肿瘤电切术后,右输尿管下端癌,多脏器转移,多器官衰竭;例3为右肾盂癌肾切除输尿管部分切除术后,膀胱癌。例1给双"J"管置入内引流术,例2给予营养支持、对症处理,例3行膀胱部分加输尿管残段切除术,BCG膀胱灌注局部化疗。全组患者随访6年,例1、例2分别于术后8个月和3个月死于肿瘤全身转移、多脏器衰竭,例3无瘤生存6年健在。 结论提高对多器官尿路上皮癌的认识,不能满足于单一器官肿瘤的诊断,不但要给予CT、MRI等检查,还需行尿脱落细胞学检查,必须行膀胱镜检查,尤其是复发性膀胱癌应警惕上尿路上皮癌同时存在的可能,正确的术式选择是延长患者生存期的关键。

Misdiagnosis of multiple organ urinary tract epithelial carcinoma and review of the literature

ObjectiveTo analyze the causes of misdiagnosis on multiple organ urothelial carcinoma and explore measures for prevention. MethodsThree cases of misdiagnosis of multiple organ urothelial cancer from February 2006 to October 2012 were retrospectively analyzed. ResultsCase 1 and case 2 were diagnosed as bladder transitional cell carcinoma for the first time, and had turbt in other hospital several times.Case 1 underwent laparoscopic radical cystectomy nephrectomy, nephrectomy and Bricker operations in other hospitals three months ago.Case 2 undergone renal ureter resection outside the hospital before admission.Case 3 underwent partial excision of kidney and ureter as renal pelvic cancer outside the hospital.After admission, all patients do urine cytology and B ultrasound, IVP, CTU or MRI examinations and cystoscope examination.Case 1 wasdiagnosed as recurrent bladder cancer after operation, right ureteral stump cancer after nephrectomy, left kidney seeper, kidney function incomplete, systemic multiple metastases.Case 2 was diagnosed as recurrent after transurethral resection of bladder tumor, right lower ureteral cancer, multiple organ metastasis, multiple organ failure.Cases 3 was diagnosed as carcinoma of renal pelvis and ureter right nephrectomy after partial resection, bladder cancer.Case 1 had double "J" tube drainage.Case 2 was given nutritional support and symptomatic treatment. Case 3 was given resection of bladder and ureter segments, and local chemotherapy for BCG bladder perfusion.All patients were followed up for six years.Case 1, case 2 died of tumor metastasis, multiple organ failure eight months and three months later respectiuely after surgery.Case 3 disease-free survived for six years and was still alive. ConclusionsTo improve the understanding of multiple organ urothelial cancer, it can not meet a single organ tumors diagnosis.Patients examined by CT, MRI, urine cytology, and all patients must do cystoscopy.Especially to the patients with recurrent bladder cancer, we should consider the possibility of upper tract cancer at the same time.Selecting the proper operation method is the key to the prolongation of survival.