膀胱癌术后发生的肾盂输尿管癌临床分析

Transitional cell carcinoma of renal pelvis and ureter after surgical treatment of bladder cancer

目的 探讨膀胱癌术后发生肾盂输尿管癌的危险因素、诊断及治疗方法。 方法 回顾性分析 13例膀胱癌术后发生肾盂输尿管癌的临床资料。男 9例 ,女 4例。肾盂癌 9例 ,输尿管癌4例。临床表现为腰部胀痛并间歇性、无痛性肉眼血尿 11例。体检B超发现肾盂占位病变 ,怀疑肾盂癌 2例。原膀胱癌单发 9例 ,多发 4例 ;分级G1～G2 12例 ,G2 ～G3 1例 ;分期T1N0 M0 ～T2 N0 M012例 ,T3 N0 M0 1例。 结果 B超病灶定位准确率 10 / 13,上尿路梗阻诊断率 13/ 13;IVU病灶定位准确率 8/ 13,上尿路梗阻诊断率 8/ 13,肾脏不显影 5 / 13;CT病灶定位准确率 13/ 13,确诊率 11/ 13。行根治性上尿路全切术 11例 ,输尿管部分切除术 2例。 13例随访 6～ 6 1个月 ,未见肿瘤复发或转移。除 1例因对侧肾结石致肾功能不全 (Cr 2 85 μmol/L)外 ,其余患者肾功能均正常。 结论 原膀胱癌为多源性及尿路上皮有致癌倾向可能是发生此病的危险因素 ;IVU结合B超检查应作为诊断首选方法 ,根治性上尿路切除术为首选治疗方法。

Objective To explore the risk factors, di ag nosis and treatment of renal pelvis and ureter cancer after surgery of bladder c ancer. Methods The clinical data of 13 patients (9 males and 4 females) with renal pelvis and ureter cancer after surgical operation of bladder cancer were retrospectively analyzed.Among them renal pelvis cancer was diagnosed in 9 cases;ureter cancer in 4.Clinical manifestations consisted of gro ss hematuria with flank pain in 11 cases,suspected renal pelvis cancer by ultras ound (US) in 2. Results Among the 13 patients,US,intrave nous urography (IVU) and CT located the focus exactly in 10,8 and all the 13 cas es,respectively.Upper urinary obstruction was diagnosed by US and IVU in 13 and 8 cases,respectively.No image was developed by IVU in 5 cases.CT located the foc us exactly in all the 13 cases;of them 11 cases were definitely diagnosed.Overal l,13 cases were cured and alive during the follow-up period. No recurrence or m etastasis developed.Renal dysfunction occurred in only 1 case (Cr,285 μmol/L) d ue to the contralateral renal stones. Conclusions Multif ocal bladder cancer and cancerogenic tendency of urothelium may be the risk fact ors of this disease.IVU combined with US is the main diagnostic method for the d isease.CT is recommended for the further examination.Nephroureterectomy is the p referred treatment choice for this disease.