肾盂鳞状细胞癌临床特点分析

Clinical analysis of squamous cell carcinoma of renal pelvis

目的探讨肾盂鳞状细胞癌的诊治特点。方法回顾性分析1991年10月至2009年5月收治8例肾盂鳞状细胞癌患者资料。临床表现血尿8例，腰痛7例，腹部包块1例。B超检查8例，IVU检查8例，CT检查4例。术前诊断为肿瘤3例，诊断为肾结石5例，结石术中发现肿瘤并经冰冻病理确诊2例。8例患者均经手术治疗，行根治性肾输尿管切除4例、单纯性肾切除3例、姑息性切除术1例。结果8例病理诊断均为鳞状细胞癌。中分化6例，高分化和低分化各1例；pT1 1例，pT2 1例，pT3 3例，pT4 3例；淋巴结转移2例。获随访7例，失访1例。术后生存时间2～42个月，中位时间6个月，患者均死于肿瘤复发及转移。结论 肾盂鳞状细胞癌恶性程度高，常合并结石，术前诊断困难，确诊时多为中晚期，术后短期内易复发转移，预后极差。

Objective To review the diagnosis and treatment of squamous cell carcinoma of renal pelvis. Methods The clinical data from October 1991 to May 2009 of eight cases of squamous cell carcinoma of renal pelvis were reviewed and analyzed retrospectively. The symptoms of the patients were hematuria （eight cases）, pain （seven cases） and abdominal mass （one case）. All patients underwent B ultrasound and IVU examination and four cases underwent CT scan. Three cases were diagnosed as having a tumor before surgery. Five cases were.diagnosed as renal calculus, two of the five cases were diagnosed by intraoperative frozen section. Radical nephroureterectomy were per- formed in four cases, nephrectomy in three cases and palliative resection in one case. Results Histo logical classification revealed that six cases were moderately differentiated, one case was well differentiated and one case was poorly differentiated. Two cases had stage pT1/pT2 and six cases had stage pT3/pT4. 2 cases had regional lymph nodes metastasis. Seven cases were followed-up. All patients died of tumor recurrence or metastasis. The median tumor specific survive time was six months （range from two months to 42 months）. Conclusions Squamous cell carcinoma of renal pelvis is often oc curs concurrently with urolithiasis which could lead to difficulty in diagnose before operation. As the most of the patients were diagnosed with advanced stage disease, squamous cell carcinoma of renal pelvis tended to early recurrence and metastasis and the prognosis was very poor.