输尿管肿瘤致肾盂输尿管自发性破裂临床分析(附4例报告)

目的探讨输尿管肿瘤导致肾盂输尿管自发性破裂的临床诊治特点。方法总结4例输尿管下段肿瘤导致肾盂输尿管自发性破裂患者的临床资料。4例中男、女各2例,年龄56～72岁。突发腰痛起病3例,突发右上腹痛伴休克1例;4例CT扫描均有肾盂积水及输尿管近端扩张,3例CT平扫显示肾周积液,增强扫描提示积液中造影剂外溢,1例合并尿毒症患者超声显示腹膜后巨大血肿。结果3例行一侧肾输尿管全长切除术,1例先行输尿管下段狭窄段探查切除,病理证实为高级别尿路上皮癌,1周后行肾输尿管全长切除术。4例患者均经病理证实为尿路上皮癌。2例术后行局部放疗,1例放疗结束后接受吉西他滨化疗。CT随访6～24个月,3例未见局部复发及转移,1例术后3个月出现局部复发及全身多发转移,8个月时死于全身脏器衰竭,恶液质。结论肾盂输尿管自发破裂临床少见,输尿管肿瘤所致上尿路梗阻是其病因之一,根治性手术为首选治疗方式。

Spontaneous rupture of the renal pelvis and ureter caused by primary ureteral cancer (4 cases and review of literature)

Objective To study the clinic characteristics of spontaneous rupture of the renal pelvis and ureter caused by primary ureteral cancer.Methods Four cases of Spontaneous rupture of the renal pelvis and ureter caused by primary ureteral cancer were reported.Two were male and 2 were female,their age ranged from 56 to 72 years old.Three cases presented acute flank pain and one case presented acute right upper quadrant abdominal pain.All four cases had hydronephrosis and enlargement of proximal ureter in CT scan,perinephric fluid collection and extravasations of contrast medium were found in delayed enhanced CT in 3cases,one case complicated with uremia showed retroperitoneal enormous hematoma in doppler-ultrasonography.Results Unilateral nephroureterectomy was performed for all four cases,with the pathologic diagnosis of ureteral carcinoma.One patient accepted local radiotherapy and chemotherapy with gemcitabine,another one accepted local radiotherapy only.CT showed no recurrence in 3 cases after followed-up,for 6～24 months,but one was found to have local recurrence and multiple metastases 3 months later,and died of exhaustion 8 months after surgery.Conclusions Obstruction caused by ureteral tumor is one of the reasons of rare spontaneous rupture of the renal pelvis and ureter.Radical operation is the preferred treatment approach.