CAJ | 학술논문

目的提高对肾结石合并肾盂癌的诊治水平. 方法 2008年6月至2012年10月收治的肾结石合并肾盂癌患者13例,男8例,女5例.年龄49～73岁,平均59岁.肾结石病史平均16年.患者均行B超检查,仅1例发现肾脏软组织占位病变.IVU检查8例,未发现肾脏软组织占位病变.CT检查7例,发现肾脏软组织占位4例.尿液多色荧光原位杂交探针检查2例,均为阳性.6例经皮肾镜取石术(PCNL)中发现肾盂黏膜病变,依据活检病理结果,4例行肾盂癌根治术,2例行根治性肾切除术.2例PCNL术后仍反复肉眼血尿,经输尿管软镜检查及活检确诊为肾盂尿路上皮癌,行肾盂癌根治术.4例术前CT检查发现肾脏软组织占位者均行肾盂癌根治术.1例肉眼血尿患者因高龄并肾功能不全,行经尿道输尿管镜下肾盂肿瘤钬激光汽化术. 结果 13例患者术后病理诊断为肾盂尿路上皮癌7例,尿路上皮癌并鳞状细胞癌化生4例,鳞状细胞癌2例.8例行PCNL者术后结石成分分析结果为感染性结石6例,混合性含钙结石2例.3例尿路上皮癌患者术后随访1～2年,未发现肿瘤复发；1例腔内肾盂肿瘤汽化术患者,术后10个月肿瘤复发,再次行腔内肿瘤汽化术；1例鳞癌并局部淋巴结转移者术后13个月因肿瘤转移死亡. 结论年龄较大、结石病史长、合并感染且严重血尿或取石后仍血尿的患者,应考虑合并肾盂癌的可能.CT与尿液多色荧光原位杂交探针检查对诊断肾结石合并肾盂癌有一定价值.腔内结石手术中对可疑肾盂黏膜病变应常规活检.早期诊断和手术是治疗肾结石合并肾盂癌的关键.
목적 제고대신결석합병신우암적진치수평. 방법 2008년6월지2012년10월수치적신결석합병신우암환자13례,남8례,녀5례.년령49～73세,평균59세.신결석병사평균16년.환자균행B초검사,부1례발현신장연조직점위병변.IVU검사8례,미발현신장연조직점위병변.CT검사7례,발현신장연조직점위4례.뇨액다색형광원위잡교탐침검사2례,균위양성.6례경피신경취석술(PCNL)중발현신우점막병변,의거활검병리결과,4례행신우암근치술,2례행근치성신절제술.2례PCNL술후잉반복육안혈뇨,경수뇨관연경검사급활검학진위신우뇨로상피암,행신우암근치술.4례술전CT검사발현신장연조직점위자균행신우암근치술.1례육안혈뇨환자인고령병신공능불전,행경뇨도수뇨관경하신우종류화격광기화술. 결과 13례환자술후병리진단위신우뇨로상피암7례,뇨로상피암병린상세포암화생4례,린상세포암2례.8례행PCNL자술후결석성분분석결과위감염성결석6례,혼합성함개결석2례.3례뇨로상피암환자술후수방1～2년,미발현종류복발；1례강내신우종류기화술환자,술후10개월종류복발,재차행강내종류기화술；1례린암병국부림파결전이자술후13개월인종류전이사망. 결론년령교대、결석병사장、합병감염차엄중혈뇨혹취석후잉혈뇨적환자,응고필합병신우암적가능.CT여뇨액다색형광원위잡교탐침검사대진단신결석합병신우암유일정개치.강내결석수술중대가의신우점막병변응상규활검.조기진단화수술시치료신결석합병신우암적관건.
Objective To discuss the diagnosis and treatment of renal pelvic carcinoma associated with renal stone.Methods A total of 13 patients,aged from 49 to 73 years old and averaged 59years old.The history of renal stone was 16 years.13 patients accepted B ultrasound check and 1 was found soft tissue occupying.8 patients accepted IVU check and none was found soft tissue occupying.7 patients accepted CT scan and 4 were found soft tissue occupying.The fluorescence in situ hybridization (FISH) examination was done for 2 patients and both were positive.6 patients were found lesions at renal pelvis mucous membrane during the operation of percutaneous nephrolithotripsy,4 accepted radical operations of renal pelvic carcinoma and 2 patients accepted radical nephrectomy according to the biopsy pathology.4 were found soft tissue occupying before operation and accepted radical operation of renal pelvic carcinoma ultimately.1 patient suffered gross hematuria and renal insufficiency accepted the renal pelvic carcinoma vaporization under the ureteroscope.Results The pathology showed that 7 cases were transitional cell carcinoma,4 were transitional cell carcinoma combined squamous cell carcinoma (SCC) metaplasia and 2 were squamous cell carcinoma.6 of 8 patients' stone chemical composition were infection stone and 2 were calcic blended stone.3 patients were followed up 1 to 2 years and survival with no tumor recurrence.The tumor recurred 10 months of the patient accepted the operation of renal pelvic carcinoma vaporization and accepted vaporization again.1 patient bsuffered SCC and local lymph node metastasis.He died 13 months post-operation.Conclusions For the patient who had long history of stone,combining infection with symptoms of severe hematuria and postoperation hematuria,the possibility of renal pelvic carcinoma should be considered.CT scan and urine FISH may help for diagnosis.The biopsy should routinely perform for the doubtful mucosa lesion during the cavity stone operation.Early and timely diagnosis and operation is the key for the patients with pelvic carcinoma associated with renal stone.