鹿角形肾结石合并肾盂癌的诊治

Diagnosis and treatment of staghorn renal calculi combined with renal pelvic carcinoma

目的：提高鹿角形肾结石合并肾盂癌的诊治水平。方法：回顾性分析16例鹿角形。肾结石合并肾盂癌患者的临床资料。结果：16例患者中，13例行CT检查，确诊4例；2例行MRI检查，确诊1例。术前确诊的5例患者行根治性肾输尿管切除加膀胱袖状切除。5例分别于开放手术或PCNL术中发现新生物，活检证实后行根治性肾切除加输尿管部分切除。1例行经皮肾镜取石术（PCNL）者后2个月再次手术时发现转移而被迫放弃手术。5例无功能肾者于肾切除术后常规病检发现合并肾盂癌。病理检查证实为鳞状细胞癌12例，移行细胞癌3例，腺癌1例。获随访10例，随访时间1～35个月，死亡7例，术后生存时间1～27个月。结论：鹿角形肾结石合并肾盂癌诊断困难，预后差。对结石病史长、合并感染或肉眼血尿者，术前应考虑合并肾盂癌的可能。CT与MRI检查对诊断鹿角形肾结石合并肾盂癌有重要价值；对术前未确诊而又怀疑结石合并肾盂癌患者，建议行开放手术，勿选PCNL。

Objective： To improve the diagnosis and treatment of staghorn renal calculi combined with renal pelvic carcinoma. Method： The clinical data of 16 cases with staghorn renal calculi combined with renal pelvic carcinoma were analyzed retrospectively. Result： CT scanning was performed in 13 of them, which indicated four cases were diagnosed with renal pelvic carcinoma. MRI was performed in two cases, which renal calculi associated with renal pelvic carcinoma was confirmed in one case. Five cases who had been diagnosed before operation were performed radical nephroureterectomy and bladder-cuff resection. Five cases were found a neoplasm in the renal pelvis during the open surgery or percutaneous nephrolithotomy （PCNL）, and radical nepbrectomy and partial ure- terectomy were performed after the biopsy indicated carcinoma. Two months after PCNL one patient was found the cancer invaded widely perinephric tissue and muscle during the second open surgery and abandoned operation. Five cases with staghorn calculi and nonfunctional kidney were diagnosed of renal pelvic carcinoma by pathology af- ter nephrectomy. The results of pathology were as follows： squamous cell carcinoma was found in 12 cases; three cases were found transitional cell carcinoma; one ease was discovered adenocarcinoma. Ten patients were followed up for 1--35 months. Seven cases were dead. The postoperative survival time was 1--27 months. Conclusion： The diagnosis of staghorn renal calculi combined with renal pelvic carcinoma before operation is difficult and the prognosis is poor. The carcinoma of renal pelvis should be considered before surgery in the patients with long history of staghorn renal calculi, infection or gross hematuria. CT scanning and MRI play a key role in the diagnosis of staghorn renal calculi associated with renal pelvic carcinoma. Open surgery is superior to PCNL for the preoper- ative patient who was suspected staghorn renal calculi combined with renal pelvic carcinoma.