尿路上皮移行细胞癌肺转移18例临床分析

Clinical analysis pulmonary metastasis in 18 cases of transitional cell carcinoma of urinary tract

目的探讨尿路上皮移行细胞癌肺转移的临床特点及治疗方法。方法收集整理天津医科大学第二医院2005年7月-2009年3月收治的18例尿路上皮移行细胞癌肺转移患者的临床资料,并进行分析总结。结果18例尿路上皮移行细胞癌的原发部位分别为肾盂(8例)、输尿管(6例)、膀胱(4例)。双肺多发转移14例,X线胸片示双肺弥漫性大小不等结节致密影,CT检查见双肺满布大小不等结节状软组织影,均给予全身化疗,其中13例膀胱局部复发者行手术治疗;孤立肺转移4例,X线胸片示孤立性团块状结节致密影,CT示肺部近胸壁软组织影,行放射性粒子植入术及全身化疗,其中1例膀胱局部复发者行手术治疗。所有患者随访6～36个月,其中6～12个月死亡2例,12～24个月死亡14例,2例生存超过24个月。结论尿路上皮移行细胞癌肺转移发生率较低,X线胸片及胸部CT检查是主要的诊断手段。对于弥散性肺转移者全身化疗是主要治疗手段,对于局限性肺转移者可选择放射性粒子植入术及全身化疗,膀胱局部复发者可给予局部手术治疗。

Objective To investigate the clinical characteristics and treatment method of pulmonary metastasis of transitional cell carcinoma of urinary tract. Methods The clinical data of 18 patients with pulmonary metastasis of transitional cell carcinoma of the urinary tract, who were admitted to the Second Hospital of Tianjin Medical University from July 2005 to March 2009 were analyzed. Results The primary sites of transitional cell carcinoma of these 18 patients were renal pelvis （8 cases）, ureter （6 cases） and bladder （4 cases）. Multiple metastases to both lungs were found in 14 cases, the chest Xray showed dense nodular shadows in different size diffused in both lungs, and CT examination revealed the same picture. All the 14 patients were treated with systemic chemotherapy, and 13 of them underwent surgical operation after the discovery of local recurrence in their bladders. Isolated lung metastasis was found in 4 cases, in whom chest X- ray showed isolated dense nodular shadow in the lung, and CT examination revealed soft tissue shadows adjacent to the chest wall. All the 4 patients were treated with implantation of radioactive pellets and systemic chemotherapy, and one of them underwent surgical operation after the discovery of a local recurrence in the bladder. Follow-up was conducted for 6--36 months. Two patients died in 6--12 months, 14 died in 12--24 months, and 2 survived for longer than 24 months. Conclusions The incidence of pulmonary metastasis of transitional cell carcinoma of urinary tract is low. Chest radiograph and CT are the main diagnostic means. Systemic chemotherapy should be used as the main treatment for diffuse pulmonary metastasis, radioactive pellet implantation and systemic chemotherapy should be used for a localized isolated pulmonary metastasis, and surgical operation should be done for the patient with local recurrence in the bladder.