肾结石并肾盂癌的诊治

目的探讨肾结石合并肾肿瘤的诊断与治疗方法。方法回顾性分析7例肾结石合并肾肿瘤患者的病例资料。结果7例患者中，1例术前IVU、B超及CT均提示肾盂癌，另6例IVU及B超均未发现肾盂癌，其中2例经术前CT检查发现肾盂内肿瘤性占位；2例PCNL术后因出血行CT检查发现肾盂肿物；1例PCNL术中发现肾盂肿物，后病理证实为肾盂癌；1例由肾切除术后病理证实。7例均接受根治性肾输尿管全切术。对所有患者进行随访，1例因肾盂癌在皮肤切口处种植，后转移至全身多处，6个月后死亡。余6例患者在随访期间未发现肾盂癌复发或转移。结论肾结石合并肾盂癌的诊断较困难，应联合影像学、病理活检等对其筛查，以期尽早明确诊断。当作出肾结石合并肾盂癌的诊断后，应放弃对结石的治疗，尽快行根治性肾输尿管全切术。

Diagnosis and treatment of renal calculi associated with renal pelvic carcinoma

Objective To investigate the diagnosis and treatment of renal calculi associated with renal pelvic carcinoma. Methods Retrospective analysis of clinical data of 7 cases with renal calculi associated with renal pelvic carcinoma had been conducted. Results The diagnosis were confirmed in 3 before PCNL cases with IVU, ultrasound and CT scan, 2 with preoperative CT scan. The remaining were diagnosed during or postoperation： 2 cases with hemorrhage after PCNL received CT scan which found renal pelvic carcinoma, one was diagnosed as having pelvic tumor when performed PCNL, one was confirmed by pathology after nephrectomy. All were performed radical nephroureterectomy and intravesical instillation therapy. One died of renal pelvic carcinoma metastasis 6 months after surgery. No recurrence or metastasis was noted in other 6 cases during follow-up. Conclusions The prediagnosis of renal calculi associated with renal pelvic carcinoma is difficult. When this disease is confirmed, we should give up to treat the renal calculi and perform radical nephroureterectomy as soon as possible.