肾实质浸润型尿路上皮癌的诊断与治疗

Diagnosis and treatment of invasive renal parenchyma urothelial carcinoma

目的探讨肾实质浸润为主的肾盂尿路上皮癌的诊断治疗。方法回顾8例肾实质浸润型尿路上皮癌患者临床资料。男6例，女2例。43～78岁，平均64岁；左侧3例，右侧5例。肿瘤直径3．0～8．5cm，平均5．2cm。TNM分期为Ⅲ期2例，Ⅳ期6例，G2级2例，G3级6例。结果8例患者均行手术治疗，肾输尿管全切＋膀胱部分切除术4例。肾切除术4例，且1例行肾上腺切除＋腔静脉取瘤栓术。术后病理均为尿路细胞癌，伴鳞状分化2例。侵犯肾包膜或肾周脂肪6例，肾门淋巴结转移4例，输尿管浸润3例，下腔静脉癌栓并同侧肾上腺转移1例，合并膀胱癌1例。8例均获随访，随访时间3个月-4年，6例死亡，平均存活9个月；另2例分别存活13个月及4年。结论肾实质浸润型尿路上皮癌早期影像学诊断困难，易发生浸润及转移，预后差。积极的手术探查对明确诊断、争取更好预后有重要意义。

Objective To discuss the diagnosis and treatment of the invasive renal parenchyma urothelial carcinoma （IRPUC）. Methods The clinical data of 8 cases of 1RPUC were reviewed retrospectively. Of all patients, 6 were male and 2 were female, aged 43 - 78 years, mean 64 years. The carcinomas were located at the left in 3 cases and at the right in 5 cases, with the diameter being 3.0 - 8.5 cm, mean 5.2 cm. According to WHO grading system, 2 cases were in G2 and 6 cases were in G3. According to the TNM clinical stage, 2 cases were in stage HI and 6 cases in stage IV. Results Four patients received nephroureterectomy with bladder partly excision, and the other 4 underwent ne- phrectomy, among whom 1 case also received adrenalectomy and postcava tumor excision. Postoperative pathology showed that all cases were urothelial carcinoma, and 2 cases were complicated with squamous differentiation. Altogether 6 cases had metastasis in renal capsule, 4 in renal portal, 3 in ureter, 1 in postcava and adrenal gland, and 1 in bladder. During the follow-up of 3 months to 4 years, 6 cases died, with an average survival time of 9 months; the other 2 cases survived for 13 months and 4 years respectively. Conclusion Invasive renal parenchyma urothelial carcinoma is prone to infiltration and metastasis with poor prognosis. As early imaging diagnosis is difficult, exploratory operation is signif- icant for confirmed diagnosis and better prognosis.