同侧肾盂尿路上皮癌并发鳞状细胞癌的诊疗分析

Diagnosis and Treatment of Renal Pelvis Urothelial Carcinoma and Squamous Cell Carcinoma

目的探讨同侧肾盂尿路上皮癌并发鳞状细胞癌的临床特点及诊疗经验。方法回顾性分析4例该病患者的临床资料:3例临床表现为腰部或胁肋部不适、隐痛或胀痛,1例因血尿发现,4例均有患侧肾结石病史(20~45年,平均30年);伴发热者2例,左侧骶髂关节疼痛者1例,右侧第6肋骨疼痛者1例;血清结核DNA均<1000IU/ml;行CT检查4例,IVU检查3例,B超检查3例,KUB检查1例,全身骨扫描2例。术前诊断为肿瘤1例,误诊为结核1例,诊断为肾多发结石2例;肾结石术中发现肿瘤并经快速冰冻病理确诊2例。4例患者均经手术治疗,行根治性肾输尿管全切除者3例,根治性肾切除者1例。结果 4例患者病理诊断均为尿路上皮癌并发鳞状细胞癌,其中低分化3例、中分化1例,T_3N_1M_0者2例、T_3N_1M_1者1例、T_4N_2M_1者1例。术后均获随访,生存时间50天~14个月,中位生存时间5个月,患者均死于肿瘤复发及转移。结论 CT、IVU检测对于肾盂尿路上皮癌并发鳞状细胞癌的诊断具有重要意义,根治性肾输尿管全切除术是治疗本病的较好方法,但本病预后极差。

Objective To study and explore the diagnosis and treatment of renal pelvis urothelial carcinoma and squamous cell carcinoma. Methods The clinical data of 4 cases urothelial carcinoma and squamous cell carcinoma of renal pelvis were retrospectively analyzed. 3 cases manifested nonspecific symptoms and signs,including flank or waist pain or gas pains,and 1 case with hematuria. There were 4 cases with renal calculi history（ 20 ~ 45 years,30 years in average）,2 cases with fever,1 case with left sacroiliac pain and 1 case with right costalgia. All the serum TB-DNA were under 1000 IU/ml. All patients underwent CT scan,3 cases underwent B-ultrasound and IVU examination,1 case underwent KUB and 2 cases underwent whole body bone scan. 1 case was preoperatively diagnosed as renal pelvis tumor and 1 case was preoperatively diagnosed as nephronophthisis. 2 cases were diagnosed as renal calculi,both of cases were diagnosed by intraoperative frozen section.Radical nephroureterectomy were performed in 3 cases and nephrectomy in 1 case. Results All of 4 cases were diagnosed renal pelvis with urothelial carcinoma and squamous cell carcinoma by pathology. Histological classification revealed that 3 cases were poorly differentiated and 1 case was moderately differentibated. By stages,2 cases were T_3N_1M_0,1 case was T_3N_1M_1 and 1 case was T_4N_2M_1. The mean survival time was 5 months（ ranged from 50 days to 14 months）. Conclusions CT scan and IVU examination were helpful for the diagnosis of the renal pelvis urothelial carcinoma and squamous cell carcinoma,radical nephroureterectomy was the optimal alternative for the treatment,but the prognosis was very poor.