肾结石伴积水合并肾盂肿瘤的诊治(附5例报告)

Diagnosis and treatment of hydrocephalus-accompanied renal calculi complicated with renal tumor:5 case reports

目的:探讨肾结石伴积水合并肾盂肿瘤患者的诊断、治疗和随访。方法:分析北京大学人民医院2011年3月至2014年3月期间肾结石积水合并肾盂肿瘤5例患者的临床资料及其诊治经过。结果:5例患者在结石术前均未发现合并肾盂肿瘤。3例在肾结石术中行肾盂黏膜活检确诊肾盂癌;1例术后经影像学复查确诊;1例因感染症状行肾盂血肿清除术,通过肾盂黏膜活检确诊。5例患者中,肾盂癌根治术1例,肾盂肿瘤电灼术1例,肾动脉栓塞术2例,另1例因肿瘤晚期失去手术机会而放弃治疗。行手术治疗的4例患者术后随访至2014年3月,行肾盂癌根治术和肾盂肿瘤电灼术的2例患者未见肿瘤进展;行肾动脉栓塞术的2例患者,1例因出现新的肿物影再次行肾动脉栓塞术,另1例患者于栓塞术后2周复查发现肿瘤略增大。结论:肾结石积水合并肾盂肿瘤患者临床较为隐匿,容易漏诊;解除梗阻、肾脏血供改善后肾盂肿瘤往往进展迅速,对此类患者的早期诊断、积极干预和严密随访非常必要。

Objective：To investigate the diagnosis and treatment of renal pelvic tumor combined with renal urinary calculi and hydronephrosis. Methods： Five patients with renal pelvic tumor who underwent relief of the upper urinary obstruction were reviewed. Results： One of the cases lost the opportunity of surgical therapy when pelvic tumor was detected at the advanced stage, and the other 4 cases had re- ceived surgery and were followed up. Conclusion：As pelvic tumor progresses rapidly after the renal blood flow is improved, and renal urinary calculi with hydronephrosis relieved; the patients with renal pelvic tumor need early diagnosis, aggressive treatment and close follow-up.