肾结石并发肾盂癌的诊治

目的 提高肾结石并发肾盂癌的诊治水平.方法 肾结石并发肾盂癌患者21例.病史10 d～24年,平均27个月,临床表现反复寒战、发热、消瘦3例;全程肉眼血尿17例,其中2例有典型的血尿、疼痛、腹部肿块表现.CT检查17例,提示肾盂肿瘤9例,疑肾下极肿瘤4例,肾门淋巴结肿大2例.MRU检查10例,诊断为肾结石并发肾盂癌9例.21例IVU检查.患肾显影浅淡13例,其中3例显示肾盂内充盈缺损,不显影8例.术前确诊9例,行患肾根治性肾切除及局部淋巴结清扫术;5例因脓肾先行肾造瘘术,二期行包膜下肾切除术,其中2例术后证实为肾盂移行细胞癌,加行残端输尿管全切加膀胱袖状切除;3例因肾多发结石无功能术中黏连严重,行包膜下肾切除术;3例术前诊断为肾脏复杂多发性结石,因肾脏无功能或功能差行患肾切除加输尿管部分切除,其中2例术后证实为肾盂移行细胞癌,加行残端输尿管全切加膀胱袖状切除;1例B超引导下行微创经皮肾镜取石术,发现肾盂肿物,术中病理切片考虑为肾盂黏液腺癌,二期行根治术及肾门淋巴结清扫术. 结果 21例均经术后病理诊断证实,其中移行细胞癌4例、鳞状细胞癌16例、黏液腺癌1例.21例均顺利出院.获随访9例,随访时间4～28个月.死亡6例,术后生存时间3～21个月,其中死于心肌梗死2例,癌肿转移4例. 结论 高龄、结石病史长、患肾积液及感染明显的肾结石,术前应考虑合并肾盂癌的可能;CT与MRU检查对诊断肾结石合并肾盂癌有重要价值;早期诊断、早期处理肾结石并发肾盂癌可延长患者存活期.

Diagnosis and treatment of carcinoma of renal pelvis accompanied with kidney stones

Objective To discuss the diagnosis and treatment of carcinoma of renal pelvis ac-companied with kidney stones. Methods Twenty-one cases of carcinoma of renal pelvis with kidney stones were reviewed. The urinary stones history was from 10 d to 24 years with an average of 27 months. Four cases had recurrent fever, weight loss. Seventeen cases had gross hematuria. CT scan-ning was performed in 17 cases, which indicated 9 cases of carcinoma of renal pelvis, 4 cases of possi-ble renal mass and enlarged renal hilum lymph nodes. MRU was performed in 10 cases, which showed 9 cases of stones concomitant with carcinoma of renal pelvis. IVU indicated 13 cases of light filling of contrast and 8 cases of complete negative filling. Nine cases who had been diagnosed before surgery were performed radical nephrectomy and local lymph nodes dissection. Five cases were carried out ne-phrostomy first because of pyonephrosis, then secondary subcapsule nephrectomy was performed, 2 of them who were diagnosed with carcinoma of renal pelvis after surgery were performed with ureterecto-my and excision of bladder cuff. Three cases were performed with subcapsule nephrectomy because of dense perinephric adhesion. Three cases with complicated calculi and nonfunctional kidney were per-formed with nephroureterectomy, 2 of them who were diagnosed with carcinoma of renal pelvis were carried out with ureterectomy and excision of bladder cuff. One case who was performed PCNL under ultrasound guidance was found a mass in the renal pelvis. The pathological examination indicated ade-nocarcinoma. Radical nephrectomy and lymphadenectomy of renal hilum were performed afterwards. Resnlts Twenty-one cases were performed with pathological examination, in which there were 4 ca-ses of transitional cell carcinoma, 16 cases of squamous cell carcinoma and 1 case of adenocarcinoma. All the 21 cases were discharged after surgery. Nine of them were followed up with 4 to 28 months. Six cases were dead. The post-surgery survival time was 3 to 21 months. Two of them died of heart infarction, 4 died of metastasis. Conclusions The carcinoma of renal pelvis should be considered be-fore surgery in the patients with long history of renal calculi, hydronephrosis and infection. CT scan-ning and MRU are helpful for the diagnoses of renal calculi concomitant with carcinoma of renal pel-vis. Earlier diagnosis, earlier management of renal calculi can extend survival time of the patients with renal calculi concomitant with carcinoma of renal pelvis.