肾实质浸润型尿路上皮癌的诊断与治疗

目的 探讨肾实质浸润为主的肾盂尿路上皮癌的诊断治疗。方法 回顾8例肾实质浸润型尿路上皮癌患者临床资料。男6例，女2例。43～78岁，平均64岁；左侧3例，右侧5例。肿瘤直径3.0～8.5cm，平均5.2cm。TNM分期为Ⅲ期2例，Ⅳ期6例，G2级2例，G3级6例。结果 8例患者均行手术治疗，肾输尿管全切+膀胱部分切除术4例，肾切除术4例，且1例行肾上腺切除+腔静脉取瘤栓术。术后病理均为尿路细胞癌，伴鳞状分化2例。侵犯肾包膜或肾周脂肪6例，肾门淋巴结转移4例，输尿管浸润3例，下腔静脉癌栓并同侧肾上腺转移1例，合并膀胱癌1例。8例均获随访，随访时间3个月～4年，6例死亡，平均存活9个月；另2例分别存活13个月及4年。结论 肾实质浸润型尿路上皮癌早期影像学诊断困难，易发生浸润及转移，预后差。积极的手术探查对明确诊断、争取更好预后有重要意义。

Diagnosis and treatment of invasive renal parenchyma urothelial carcinoma

Objective To discuss the diagnosis and treatment of the invasive renal parenchyma urothelial carcinoma (IRPUC). Methods The clinical data of 8 cases of IRPUC were reviewed retrospectively. Of all patients, 6 were male and 2 were female, aged 43～78 years, mean 64 years. The carcinomas were located at the left in 3 cases and at the right in 5 cases, with the diameter being 3.0～8.5cm, mean 5.2cm. According to WHO grading system, 2 cases were in G2 and 6 cases were in G3. According to the TNM clinical stage, 2 cases were in stage Ⅲ and 6 cases in stage Ⅳ. ResultsFour patients received nephroureterectomy with bladder partly excision, and the other 4 underwent nephrectomy, among whom 1 case also received adrenalectomy and postcava tumor excision. Postoperative pathology showed that all cases were urothelial carcinoma, and 2 cases were complicated with squamous differentiation. Altogether 6 cases had metastasis in renal capsule, 4 in renal portal, 3 in ureter, 1 in postcava and adrenal gland, and 1 in bladder. During the follow-up of 3 months to 4 years, 6 cases died, with an average survival time of 9 months; the other 2 cases survived for 13 months and 4 years respectively. Conclusion Invasive renal parenchyma urothelial carcinoma is prone to infiltration and metastasis with poor prognosis. As early imaging diagnosis is difficult, exploratory operation is significant for confirmed diagnosis and better prognosis.