CAJ | 학술논문

目的分析多器官尿路上皮癌的误诊原因并探讨其预防措施.方法回顾分析2006年2月至2012年10月收治被误诊误治等3例多器官尿路上皮癌的临床资料.3例均为男性,年龄分别为83岁、69岁和71岁,均以血尿住院.本组例1、例2首次均以膀胱移行细胞癌在外院多次行TURBt.例1曾在三个月前,在外院先后行腹腔镜下膀胱癌根治术和肾切除术、回肠膀胱术.例2在入院前,曾在外院行肾输尿管部分切除.例3以肾盂癌在外院行肾、输尿管部分切除术.在本院行尿细胞学检查和B超、IVP、CTU或MRI检查及膀胱镜检查,例1诊断为复发性膀胱癌术后,肾切除术后右输尿管残段癌,左肾积水,肾功能不全,全身多发性转移.例2为复发性膀胱肿瘤电切术后,右输尿管下端癌,多脏器转移,多器官衰竭.例3为右肾盂癌肾切除输尿管部分切除术后,膀胱癌.例1给双“J”管置入内引流术.例2给营养支持、对症处理.例3行膀胱部分加输尿管残段切除术,BCG膀胱灌注局部化疗.结果全组患者随访6年.例1、例2分别于术后8个月和3个月死于肿瘤全身转移、多脏器衰竭.例3无瘤生存6年健在.结论提高对多器官尿路上皮癌的认识,不能满足于单一器官肿瘤的诊断,不但要给予CT、MRI等检查,仍需尿脱落细胞学检查,必须行膀胱镜检查,尤其是复发性膀胱癌要警惕上尿路上皮癌同时存在的可能,以免误诊,造成严重后果.
목적 분석다기관뇨로상피암적오진원인병탐토기예방조시.방법 회고분석2006년2월지2012년10월수치피오진오치등3례다기관뇨로상피암적림상자료.3례균위남성,년령분별위83세、69세화71세,균이혈뇨주원.본조례1、례2수차균이방광이행세포암재외원다차행TURBt.례1증재삼개월전,재외원선후행복강경하방광암근치술화신절제술、회장방광술.례2재입원전,증재외원행신수뇨관부분절제.례3이신우암재외원행신、수뇨관부분절제술.재본원행뇨세포학검사화B초、IVP、CTU혹MRI검사급방광경검사,례1진단위복발성방광암술후,신절제술후우수뇨관잔단암,좌신적수,신공능불전,전신다발성전이.례2위복발성방광종류전절술후,우수뇨관하단암,다장기전이,다기관쇠갈.례3위우신우암신절제수뇨관부분절제술후,방광암.례1급쌍“J”관치입내인류술.례2급영양지지、대증처리.례3행방광부분가수뇨관잔단절제술,BCG방광관주국부화료.결과 전조환자수방6년.례1、례2분별우술후8개월화3개월사우종류전신전이、다장기쇠갈.례3무류생존6년건재.결론 제고대다기관뇨로상피암적인식,불능만족우단일기관종류적진단,불단요급여CT、MRI등검사,잉수뇨탈락세포학검사,필수행방광경검사,우기시복발성방광암요경척상뇨로상피암동시존재적가능,이면오진,조성엄중후과.
Objectives To analyze the causes for misdiagnosis of multiple organ urothelial carcinoma and explore measures for prevention.Methods 3 cares were retrospectively analzed,which were misdiagnosed as multiple organ urothelial cancer from 2006 February to 2012 October,Case land Case 2 underwent TURBT for several times case 1 underwent laparoscopic radical cystectomy and Bricker operation,nephrectomy in three mouths ago.In case 2,the patient underwent renal under resection before admission.In cases 3 with carcinoma of renal pelvis in outside the hospital kidney,ureter resection.In our hospital for urine cytology and B ultrasound,IVP,CTU or MRI examination and cystoscope examination,case 1 diagnosed as recurrent bladder cancer after operation,right ureteral stump cancer after nephrectomy,left kidney seeper,kidney function not entire,systemic multiple metastases.2 cases of recurrent after transurethral resection of bladder tumor,right lower ureteral cancer,multiple organ metastasis,multiple organ failure.3 cases of carcinoma of renal pelvis and ureter right nephrectomy after partial resection,bladder cancer.Case 1 to double "J" tube drainage.Case 2 for nutritional support,symptomatic treatment.Resection of bladder and ureter 3 part stub of local chemotherapy for bladder perfusion,BCG.Results All patients were followed up for 6 years.Case 1,case 2 respectively after 8 and 3 months died of tumor metastasis,multiple organ failure.3 cases of tumor free survival 6 years alive.Conclusions To improve the understanding of multiple organ urothelial cancer,the diagnosis should not be confined in single organs.It should be expanded to other organs,Not only CT,MRI should be performed,but also urine cytology,cystoscopy need to be done,especially in recurrent bladder cancer.Extra attention should be paid to avoid concurrent the upper urinary tract urothelial carcinoma.