肾结石伴无功能肾合并肾盂癌的漏诊分析

Analysis of missed diagnosis of renal calculi with nonfunctioning kidney and renal pelvis carcinoma

目的探讨肾结石伴无功能肾合并肾盂癌的漏诊原因。方法选取2014年6月~2019年6月我院收治的4例肾结石伴无功能肾合并肾盂癌患者为研究对象,其中男性3例,女性1例;年龄70~78岁;肾结石病史11~16年。4例患者均出现腰痛、血尿及合并泌尿道感染,其中2例合并发热,静脉尿路造影、彩超及CT等检查均未发现肾盂癌。1例患者因合并输尿管下段结石及膀胱结石,遂行肾输尿管切除及膀胱切开取石术,其余3例行单纯肾切除。结果术后病理检查发现原发肾盂腺癌1例,肾盂尿路上皮细胞癌2例,肾盂鳞状细胞癌1例。对所有患者进行随访,1例半年后死于肿瘤复发转移,1例半年后失访,1例随访4.5年肿瘤无复发,1例随访1.5年肿瘤无复发。结论肾结石伴无功能肾合并肾盂癌患者临床表现及影像学检查无特异性,容易漏诊,年龄较大、长期肾结石合并重度肾积水伴感染的患者应考虑合并肾盂癌可能,需进一步检查,术中应常规仔细检查切除的肾脏标本。

Objective To investigate causes of escape diagnosis of renal pelvis carcinoma with non-functioning kidney due to renal calculi.Methods From June 2014 to June 2019,4 cases of renal calculi with nonfunctioning kidney combined with renal pelvis cancer in our hospital were selected as the research objects,including 3 males and 1 female,aged 70-78 years,with a history of 11-16 years.All of the 4 patients had low back pain,hematuria and urinary tract infection,of which 2 patients had fever.No renal pelvis cancer was found by intravenous urography,color Doppler ultrasound and CT.One patient complicated with lower ureteral calculi and bladder calculi underwent nephroureterectomy and cystolithotomy,and the other three underwent simple nephrectomy.Results Postoperative pathological examination revealed 1 case of primary renal pelvic adenocarcinoma,2 cases of urothelial carcinoma and 1 case of squamous cell carcinoma.All patients were followed up,1 case died of tumor recurrence and metastasis after half a year,1 case lost to follow-up after half a year,1 case had no tumor recurrence after 4.5 years of follow-up,1 case had no tumor recurrence after 1.5 years of follow-up.Conclusion It was easily to neglect the diagnosis of renal pelvis carcinoma due to non-specificity in clinical manifestations and imaging examinations.A diagnosis of renal pelvis carcinoma should be considered in a patient with aged,long-term renal calculi complicated with severe hydronephrosis and infection.Then,further examinations should be done.In addition,the specimens should be examined carefully during the operation.