双侧上尿路同时发生移行细胞癌11例报告

Synchronous bilateral transitional cell carcinoma of the upper urinary tracts(report of 11 cases)

目的:探讨双侧上尿路同时发生移行细胞癌患者的诊疗措施。方法:收集了1994年7月~2014年12月收治11例双侧上尿路同时发生移行细胞癌患者的临床资料,其中男1例,女10例。均有慢性肾功能不全、无痛性肉眼血尿,并经影像学和输尿管镜等检查确诊。4例行后腹腔镜肾输尿管全长切除术,1例行开放的肾输尿管全长切除术,2例行开放的输尿管全长切除术和肾造瘘术,4例患者拒绝手术仅行保守治疗。结果:术后病理检查均为移行细胞癌。随访11~113个月,平均37个月。随访期间6例死亡,1例术后发生膀胱肿瘤。结论:双侧上尿路同时发生移行细胞癌,根据肾功能情况可选择行保肾手术或肾输尿管切除术。保肾手术后应加强监测,以利早期发现复发和治疗。

Objective:To explore the diagnosis and treatment of the transitional cell carcinoma of synchronous bilateral upper urinary tracts.Methods:The clinical data of 11 cases with transitional cell carcinoma of synchronousbilateral upper urinary tracts were retrieved from July 1994 to December 2014,including one male and ten females.All of these 11 patients were with renal insufficiency and painless hematuria.The diagnosis was confirmed by examining ultrasound,retrograde pyelography,CT or MRU and ureteroscope.Retroperitoneal laparoscopic nephroureterectomy were performedfor4 patients and open nephroureterectomy for one.2cases were operated by open nephroureterectomy on one side and percutaneous nephrostomy on contralateral side.The rest rejected operation.Results:All of the results of the pathological examination weretransitional cell carcinoma.The mean followup for these patients was 37months(range from11 to 113months).Duringthe follow-up period,6cases died and1 casegenerated bladder tumor after operation.Conclusions:Partial nephrectomy or nephroureterectomy could be a priority choice for Synchronous bilateral transitional cell carcinoma according to renal function.Post-operative examination should be taken regularly for the one with partial nephrectomy.