上尿路移行细胞癌的诊断和治疗

上尿路移行细胞癌较为少见 ,我院 1 985～ 2 0 0 2年 1 1月共收治 42例 ,现报告如下。1　临床资料本组 42例 ,男 2 7例 ,女 1 5例 ,年龄 34～ 79岁 ,平均 43.6岁。肾盂癌 2 8例 ,左侧 1 7例 ,右侧 1 1例 ;输尿管癌 1 4例 ,左侧 6例 ,右侧 8例 ,肿瘤位于下段 9例 ,中段 4例 ,上段 1例。同时并发肾盂输尿管癌 3例。临床表现有肉眼血尿 30例 ,镜下血尿 7例 ,体检发现肾盂输尿管积水 1 2例 ,腰部疼痛2 4例 ,伴膀胱刺激征 1 6例。B超检查 42例 ,有不同程度的肾积水及输尿管扩张 33例 ,直接发现肿瘤 1 5例 ;排泄性尿路造影检查 (IVU) 42例 ,发现…     

上尿路移行细胞癌12例误诊分析

目的探讨上尿路移行细胞癌的误诊原因。方法回顾性分析12例上尿路移行细胞癌患者在诊治过程中的误诊情况。误诊为肾炎4例,上尿路结石3例,泌尿系感染3例,肾结核1例,前列腺增生1例。结果 12例患者均经手术治疗,术后病理证实肾盂移行细胞癌9例,输尿管移行细胞癌3例,伴膀胱移行细胞癌2例。通过B超、静脉尿路造影（IVU）、逆行肾盂造影、CT、输尿管镜及膀胱镜等检查均提示发现肿瘤病灶。8例患者随访6个月~15年,3例死于肿瘤进展,2例术后出现膀胱移行细胞癌。结论对长期血尿病史患者需进一步病因检查,B超、IVU、CT等影像学检查具有重要的诊断价值,同时应提高对检查结果的正确分析和判读能力。     

肾移植术后并发自体泌尿系统移行细胞癌九例的诊治体会

目的总结肾移植后并发自体泌尿系统移行细胞癌的诊治体会。方法9例患者在肾移植术后11～48个月出现间歇性血尿，通过B型超声波、静脉尿路造影（IVU）、膀胱镜、输尿管镜、逆行肾盂造影、CT及内窥镜下取材活检等，证实3例为肾盂肿瘤，2例为输尿管肿瘤，4例为膀胱肿瘤。肾盂肿瘤和输尿管肿瘤的5例均采取肾、输尿管全程及膀胱部分切除术；4例膀胱肿瘤患者中，3例行经尿道膀胱肿瘤电切术，1例施行膀胱全切及移植肾切除术。有2例患者因肿瘤复发或新发而接受了2次肿瘤切除术。术后通过膀胱灌注给予丝裂霉素、吡柔比星、表阿霉素等进行化疗。结果9例患者11次手术均顺利，治疗效果比较满意，在施行肿瘤切除术前后不需调整免疫抑制治疗方案。结论对肾移植后并发自体泌尿系统移行细胞癌的患者，关键在于早期诊断、积极治疗，应慎重对待肾移植后出现血尿的患者，以免漏诊。     

上尿路移行细胞癌的诊断与治疗（附39例报告）

目的探讨上尿路移行细胞癌的诊治方法。方法回顾性分析39例上尿路移行细胞癌患者的临床表现及诊治方法。结果39例患者均行手术治疗,术后病理检查证实29例为肾盂移行细胞癌,10例为输尿管移行细胞癌。通过B超、静脉尿路造影（IVU）、逆行肾盂造影、CT、尿脱落细胞学及输尿管镜等检查,术前诊断符合率为92.3%（36/39）。35例患者获得随访6个月-12年,6例术后出现膀胱移行细胞癌,5例死于肿瘤进展。结论B超、IVU、CT可作为上尿路肿瘤的常规检查,IVU显影不佳时逆行肾盂造影可作补充,输尿管镜配合组织活检准确性极高。根治性肾输尿管切除术效果较好,术后应行膀胱灌注治疗及定期膀胱镜检查。     

上尿路移行细胞癌26例诊治分析

目的 提高上尿路移行细胞癌的诊治水平。方法 回顾性总结1983～2003年手术和病理证实的原发性上尿路移行细胞癌26例，对其临床特点及各种检查方法的选择进行分析，并对其误诊原因进行讨论。结果 术前明确诊断22例，为84．6％。26例病理检查证实为移行细胞乳头状细胞癌，其中G1级3例，G级16例，G3级7例；Ⅰ期4例，Ⅱ期12例，Ⅲ期6例，Ⅳ期4例。得到随访21例，14例无瘤生存3个月～14年。结论 血尿、腰痛和肾积水是上尿路移行细胞癌主要临床表现。术前联合应用静脉肾盂造影检查(IVU)、B超、逆行造影、CT、MRI、膀胱镜和尿脱落细胞学等检查，可提高上尿路移行细胞癌的正确诊断率。根治性肾、输尿管膀胱袖口样切除术是治疗上尿路移行细胞癌的有效方法。     

肾盂及输尿管移行细胞癌术后的尿路再发癌

本文回顾了75例原发性肾盂及输尿管移行细胞癌的治疗。分析术后出现的尿路上皮细胞肿瘤与手术方式的关系,强调上尿路移行细胞癌的治疗应行肾输尿管膀胱部分切除术,术后要严密随访。本组肾输尿管全切者,膀胱再发癌的发病率为4.6％,而行肾及大部分输尿管切除者,输尿管残端癌发病率为40％,膀胱再发癌为20％。     

手助腹腔镜在上尿路移行细胞癌治疗中的应用

目的：探讨手助腹腔镜在肾输尿管全长切除术加膀胱袖套状切除术中的应用价值。方法：采用手助腹腔镜行肾输尿管全长切除术，加膀胱袖套状切除术治疗上尿路移行细胞肿瘤7例(其中经腹腔途径5例，经腹膜后途径2例)。病理类型均为移行细胞癌(肾盂移行细胞癌5例，输尿管移行细胞癌1例，肾盂和输尿管多发性移行细胞癌1例)。结果：7例手助腹腔镜手术均获成功。手术时间50～150min，平均97．5min；术中出血50～300ml，平均111．4ml；术后住院时间7～53d。结论：采用手助腹腔镜行肾输尿管全长切除术加膀胱袖套状切除术治疗上尿路移行细胞癌，是一种可选择的新的手术方式，与开放手术相比，具有损伤小、出血少、术后恢复快等优点。     

肾盂、输尿管癌术后对侧输尿管再发癌三例报告

1990至 2 0 0 1年我们收治肾盂或输尿管癌根治术后对侧输尿管再发癌 3例 ,现报告如下。临床资料　本组 3例。男 2例 ,女1例。年龄 5 3～ 6 5岁 ,平均 5 9岁。患者均有无痛全程肉眼血尿。左输尿管移行细胞癌 2例 ,左肾盂癌 1例。 3例均在硬外麻醉下行患侧肾根治性切除术 ,切除肾、输尿管全长及患侧输尿管周围2cm之膀胱壁。分别于首次术后 2、9、15个月再发无痛全程肉眼血尿入院。入院时查体 :患者均有不同程度全身水肿、右侧腰部轻微叩击痛。B超、IVU示右肾重度积水 ,输尿管上段扩张 ,下段未显影 ;右逆行插管造影分别于右输尿管上段和下段…     

肾结核并双侧全程尿路移行细胞癌1例

移行细胞癌是泌尿系统肿瘤常见的病理类型,其中膀胱上皮移行细胞癌约占90%～95%,上尿路移行细胞癌（肾盂癌、输尿管癌）约占5%。双侧上尿路、膀胱全程出现移行细胞癌则较为少见,而肾结核同时合并双侧全程尿路移行细胞癌则更是罕见报道。我院于2011年收治1例,报告如下。     

上尿路移行细胞癌的腔内治疗

目的 探讨上尿路移行细胞癌的腔内保守治疗疗效以及远期随访结果.方法 对6例上尿路移行细胞癌患者进行腔内治疗,5例逆行输尿管镜下电切配合钬激光烧灼,1例顺行经皮肾电切处理.结果 随访1～4年,1例肾盂移行细胞癌患者术后5个月复发,合并严重出血,行患侧肾输尿管切除.1例肾盂移行细胞癌以及1例输尿管移行细胞癌患者复发,每3～6个月复诊行输尿管镜下钬激光烧灼,另外3例患者未见肿瘤复发.结论 对于解剖或者功能性孤立肾、双侧上尿路肿瘤、肾功能不全、合并严重疾病不能耐受开放手术者以及对侧肾正常但患侧肿瘤直径小于1.5cm且级别较低患者,腔内治疗是理想的一种治疗选择.但所有患者术后都需要进行严格的随访.     

A case of synchronous contralateral renal cell carcinoma and ureteral transitional cell carcinoma

A case of synchronous contralateral renal cell carcinoma and ureteral transitional cell carcinoma is reported. A 56-year-old man, who had been incidentally found to have an abnormal mass in the upper pole of the right kidney on ultrasound sonography, was admitted on January 8, 1985. CT scanning and renal arteriography revealed right renal malignancy. Right radical nephrectomy was performed and histological examination showed adenocarcinoma, granular cell type of the right kidney. He was discharged on February 3, 1985. Two months postoperatively, he was rehospitalized for macroscopic hematuria. Left retrograde pyelogram showed obstruction at middle ureter and cytology of urine from left ureter was positive. So a left ureteral tumor was suspected, and partial resection of left ureter and ureteroureterostomy were performed. Histological examination revealed ureteral transitional cell carcinoma. He is now doing well at 6 months following the lat surgery, without any evidence of recurrence.     

Urothelial carcinoma in a remnant ureter after a radical nephrectomy for renal cell carcinoma: A case report

Urothelial carcinoma of a ureteral stump after a radical nephrectomy for renal cell carcinoma is rare. We present the case of a 76-year-old man with painless gross hematuria. The patient had undergone a right nephrectomy for renal cell carcinoma 30 months previously. Cystoscopy showed a blood clot in the right ureteral orifice, and ureteroscopy revealed a papillary mass in the right ureter. The patient underwent a right ureterectomy and bladder cuff resection. The pathology examination showed a high-grade urothelial carcinoma. However, a superficial bladder tumor was discovered postoperatively, and a transurethral resection of the bladder tumor was performed. At 8 months postoperatively, the patient was alive with no evidence of recurrence. A ureteral stump evaluation must be performed when painless hematuria is noted in patients after a nephrectomy.     

小切口后腹腔镜下根治性肾切除术17例报告

目的总结小切口后腹腔镜下根治性肾切除术的治疗经验。方法采用第12肋尖部向前下方5—6cm切口后腹腔镜下根治性肾切除术治疗肾及肾盂输尿管肿瘤患者17例。男10例，女7例，平均年龄56岁。5例因无痛性肉眼血尿就诊，余12例为B超体检发现，腹部均未扪及肿块。左侧5例，右侧12例。肾肿瘤13例直径3～10cm，平均5cm。UICC临床分期；T1N0M0 10例，T2N0M0 2例，T3aN0M0 1例；分级：G1 1例、G3 12例。肾盂输尿管肿瘤4例：T1N0M0和T2N0M0各2例，G2 3例、G3 1例．结果17例手术均顺利，其中1例肿瘤直径10cm者扩大手术切口取出标本。手术时间平均111min，平均出血90ml。未出现并发症。病理报告：肾透明细胞癌10例，嗜色细胞癌2例，血管平滑肌脂肪瘤1例；肾盂移行细胞癌3例，原发性输尿管移行细胞癌1例。17例随访2—21个月，平均12．8个月，均健在，未见肿瘤复发。结论该手术具有手术时间短，安全可靠，患者恢复快，操作简单等优点，是一种实用的手术方法。     

原发性输尿管癌26例的诊断与治疗

目的：提高原发性输尿管的诊治水平。方法：结合献回顾分析了1986/2001收治的26例原发性输尿管癌的临床特点、诊断、治疗及预后。结果：25例术后病理检查证实为输尿管移行细胞癌，主要症状有肉眼血尿，病变侧肾积水。CT及膀胱镜检查，逆行输尿管造影和输尿管镜检查为主要诊断方法，以手术治疗为主。26例中有19例得以随访，其中13例生存，9例死亡。结论：凡原因不明的血尿患，经B超或静脉尿路造影检查，发现肾积水或肾不显影时，应考虑到原发性输尿管癌的可能，其预后与肿瘤的分级及分期密切相关。早期诊断、正确治疗和预防复发是提高患生存率的关键。     

尿路上皮内翻性乳头状瘤62例临床分析

目的 探讨尿路上皮内翻性乳头状瘤的临床表现、生物学行为及临床诊治方案.方法 回顾性分析1990年1月至2008年8月62例尿路上皮内翻性乳头状瘤患者的临床资料.男性51例,女性11例,平均年龄56.4岁.单发56例,多发6例.肉眼血尿为最常见的首发临床表现.发病部位在输尿管5例,4例行肿瘤局部切除术,1例行左肾及输尿管全长切除术;发生于输尿管合并膀胱1例,行膀胱全切术;发生于膀胱52例,44例行经尿道膀胱肿瘤切除术,6例行膀胱部分切除术,2例行膀胱全切术;发生于尿道4例,1例行经尿道肿瘤切除术,3例行尿道肿瘤切除术.结果 62例患者术后病理均证实为内翻性乳头状瘤,其中伴发尿路上皮癌7例.49例随访3个月～12年.2例分别于术后7和79个月复发,3例分别在术后18个月、2年和6年发现尿路上皮癌.结论 尿路上皮内翻性乳头状瘤为良性肿瘤,需与尿路上皮恶性肿瘤相鉴别.手术是其主要治疗方式,术后应定期复查膀胱镜及随访.     

Ureteral and bladder metastases of renal cell carcinoma following synchronous renal cell carcinoma and bladder cancer; a case report

A 73-year-old man presented with gross hematuria. Ultrasonography and computerized tomography showed small bladder tumors and a left renal mass protruding to renal pelvis. Transurethral resection of bladder tumor and ureteroscopic tumor biopsy were performed, and pathological examinations revealed transitional cell carcinoma in the bladder and renal cell carcinoma in the kidney. He underwent left radical nephrectomy. A 4-month postoperative cystoscopy revealed a solitaly non-papillary tumor in the bladder. Transurethral resection was performed and pathological diagnosis was metastasis from renal cell carcinoma. At that time, multiple metastases to ureteral stump and lung were found. He had undergone palliative treatment because of his poor general condition until he died 26 months postoperatively. Care should be taken for management of ureteral stump when diagnostic ureteroscopy was done for renal cell carcinoma invading the renal pelvis.     

Primary tumor of the ureteral stump following a nephrectomy for renal cell carcinoma.

BACKGROUND: A 64-year-old man presented with asymptomatic macroscopic hematuria during a follow up for a localized renal cell carcinoma (RCC), which was treated by a right radical nephrectomy 6 years earlier. METHODS: X-rays and a ureteroscopic examination revealed multiple papillary tumors filling the right ureteral stump. Surgery was performed to excise the ureteral stump and bladder cuff. The tumor was histologically a grade 2-3 transitional cell carcinoma without muscle invasion. RESULTS/CONCLUSIONS: Only four patients with a ureteral stump carcinoma, including the present case, have been reported after a nephrectomy for RCC. Considering that this patient had a past history of multiple cancers, genetic or environmental factors may have contributed to the etiology of the ureteral stump tumor.     

肾移植术后并发尿路上皮肿瘤的临床分析

目的 分析肾移植患者并发尿路上皮肿瘤的特点，探讨其诊治方法。方法 自1998～2003年肾移植患者1293例，术后发生尿路上皮恶性肿瘤21例（1．6％）。男4例，女17例。17例原发病为慢性问质性肾炎。发生尿路上皮肿瘤距肾移植6～62个月，平均26个月。其中膀胱癌6例，单侧肾盂或输尿管癌6例，单侧肾盂或输尿管、膀胱癌8例，双侧肾盂输尿管癌1例。10例上尿路肿瘤发生部位与移植肾同侧，4例发生于移植肾对侧。临床症状以无痛性肉服血尿和反复泌尿系感染为主。19例行手术治疗，术后所有患者免疫抑制剂用量减少1／3并辅以局部灌注化疗。结果 2例行姑息性治疗的晚期肿瘤患者分别于发现肿瘤5、8个月死亡。余19例现已随访2～5年。13例肿瘤复发，复发部位为膀胱或对侧原。肾、输尿管。所有患者在免疫抑制剂减量期间均未出现急性排斥。2例因切除移植肾恢复透析，17例肾功能正常。结论 慢性间质性。肾炎导致。肾功能衰竭的。肾移植患者和女性肾移植患者易发生移植后尿路上皮肿瘤；移植肾同侧上尿路较对侧好发肿瘤；对移植肾对侧为首发的上尿路发生肿瘤者可预防性行双侧上尿路根治性切除。     

Concurrent renal cell carcinoma and transitional cell carcinoma in a chronic hemodialysis patient

A 60-year-old female patient had been on maintenance hemodialysis for 12 years was suffering from gross hematuria. Subsequent image studies revealed left renal and ureteral tumors. She then received left radical nephroureterectomy. Histological examination revealed the renal tumor was renal cell carcinoma and ureteral tumor was transitional cell carcinoma respectively. To our knowledge, this is the first reported case of simultaneous occurrence of these two urological cancers in a chronic hemodialysis patient. Our case may imply the increased susceptibility of urological malignancy in dialysis patients. Physicians should always raise the possibility of urological malignancy when a dialysis patient with gross hematuria is encountered. A thorough and careful screening for the malignancy should be performed on a regular basis in these patients with high risk.     

Transitional cell carcinoma of ureteral stump after radical nephrectomy for renal cell carcinoma

A 68-year-old male presented with microscopic hematuria during a routine checkup after undergoing a radical nephrectomy for renal cell carcinoma. Retrograde ureterography demonstrated a ureteral stump tumor. The ureteral stump was completely resected with a bladder cuff and histologic diagnosis was grade 2 to 3 transitional cell carcinoma of the ureteral stump. He is doing well and has been tumor-free for 2 years. The ureteral stump must be correctly evaluated using retrograde ureterography in any patient with a prior history of bladder cancer. Even if a patient had no history of ureterial cancer, whenever hematuria is present in the follow-up period after nephrectomy for renal cell carcinoma, a retrograde pyelogram should be performed.