肾结石合并肾盂癌的临床特征(附15例报告)

Clinical characteristics of renal calculi concomitant with renal pelvic carcinoma:additional 15 cases report

目的探讨肾结石合并肾盂癌的临床特征。方法回顾性分析15例肾结石合并肾盂癌患者的临床资料,术前确诊仅2例,确诊率13%。开放手术治疗9例,PCNL6例。其中4例行二期手术肾输尿管全切,2例拒绝进一步手术。结果术后病理检查证实肾盂腺癌2例,肾盂鳞状细胞癌10例,肾盂尿路上皮癌3例。术后随访1～24个月,11例死于肿瘤全身转移、多器官衰竭,平均生存期为11.6个月。另4例仍在随访中,目前未发现有转移。结论对于肾结石病史长、鹿角形结石、消瘦、贫血,特别是近期有腰痛加重者,应高度警惕有肾盂癌的可能,要进行尿脱落细胞学检查;对于术中发现肾盂、肾盏有新生物或周围粘连、有肿块者应行快速病理检查。

Objective To investigate the clinical characteristics of renal calculi concomitant with renal pelvic carcinoma.Methods The clinial data of 15 cases with renal calculi concomitant with renal pelvic carcinoma were analyzed retrospectively.Only 2 cases were confirmed diagnosis of renal pelvic carcinoma before operation.9 of 15 Patients were suffered from open surgery and the others by percutaneous nephrolithotripsy.4 patients performed radical nephroureterectomy subsequently and 2 patients refused further treatment.Results 2 patients were confirmed diagnosis of pyelo-adenocarcinoma by pathological examination,10 of squamous cell carcinoma and 3 of transitional cell carcinoma of renal pelvis.11 Patients died of multiple organfailure after 1 to 24 months follow-up and the mean survival time is 11.6 months.4 Patients were still in follow-up and no metastasis or recurrence.Conclusion s Patients should be on high alert after a long history of renal calculi and with emaciation or anaemia,especially with lumbago in recently.All patients should be performed frozen section when new lump of renal pelvis discovered during operation.