肾结石合并肾盂鳞状细胞癌的早期诊断与治疗(附2例报告)
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【摘要】 目的 探讨肾结石合并肾盂鳞状细胞癌的早期诊断与治疗。方法 报告肾结石合并肾盂鳞状细胞癌2例,结合相关文献探讨其早期诊断及治疗方法。结果 2例均有典型肾绞痛病史及合并血尿,CT检查提示肾盂癌2例。2例术中经冰冻病理确诊后,行根治性患肾切除术,1例术后行全身化疗,5个月后死于全身衰竭,另一类术后随访18个月无复发。2例病理诊断均为鳞状细胞癌。结论 肾结石合并肾盂鳞状细胞癌恶性程度高、预后差,临床表现缺乏特异性,易误诊和漏诊,提高对本病的认识,对可疑病例进行多项必要的辅助检查,有助于明确诊断。治疗以根治性患肾切除为主。
【关键词】 肾结石;肾盂;鳞状细胞癌;诊断;治疗
Early diagnosis and treatment of renal calculi associated with squamous cell carcinoma of the renal pelvis:a report of 2 cases
LI Huai-fu, XU Zhe-qing,ZHENG Hao,et al.Department of Urology,the Fifth Affilcated Hospital of Sun Yat-sen University,Zhuhai 519000, China
【Abstract】 Objective To investigate the early diagnosis and treatment of renal calculi associated with squamous cell carcinoma of the renal pelvis.Methods 2 cases of squamous cell carcinoma of the renal pelvis associated with renal calculi were reported in our department.The literature was reviewed to discuss the early diagnosis and treatment.Results Both of the 2 patients presented with typical renal colic and hematuria,2 cases of renal pelvic tumor were diagnosed by CT.Radical nephrectomy was performed for the 2 patients after squamous cell carcinoma was detected with frozen section during operation. One patient received systemic chemotherapy and died from cancer collapse after 5 months,the other developed no recurrence during follow-up of 18 months. Both of the 2 cases were proved squamous cell carcinoma in pathology after operation. Conclusion Squamous cell carcinoma of the renal pelvis associated with renal calculi has an aggressive behavior and unfavourable prognosis,and it may be easily misdiagnosised and missed because its clinical manifestation is lack of specificit. Once a case is suspected squamous cell carcinoma of the renal pelvis, many necessary assistance examinations should be performed for diagnosis and the optimal treatment is radical nephrectomy.
【Key words】 Renal calculi;Renalpelvis;Squamous carcinoma;Diagnosis;Therapy
肾结石合并肾盂鳞状细胞癌临床少见,症状隐匿,早期诊断较为困难,易误诊及漏诊。现将本院收治2例肾结石合并肾盂鳞状细胞癌报告如下。
1 病例资料
患者女,63岁,以“左侧腰部疼痛伴全程肉眼血尿1个月余”于2002年10月入院。患者在既往19年中曾多次诊断为左肾多发结石,先后3次在外院行左肾切开取石术。查体:双肾区无明显压痛及叩击痛。KUB+IVU提示:左肾多发结石,左侧肾盂、肾盏明显扩张,左侧输尿管中下段显影不满意。入院诊断:左肾多发结石并左肾积水;入院后行CT检查提示左肾下极体积增大,可见一3 cm×2 cm大小软组织影,CT值为36.3 Hu,略低于周围正常肾实质,增强后轻度强化,但仍低于正常周围肾实质,周围不光滑,与正常组织分界不清,尿细胞学检查未找到恶性细胞。常规术前准备后,经原腰部切口手术探查见患肾下极皮质变薄,呈囊性感,穿刺抽取少量豆腐渣样液体,于皮质变薄区切开取出2 cm×2 cm×3 cm大小结石一枚及泥沙样结石。同时切口处组织送冰冻检查提示左肾盂低分化鳞状细胞癌,即行根治性左肾切除加部分输尿管切除术及淋巴清扫术,术后常规行放化疗,5个月后死于全身衰竭。
患者男,67岁,以“体检发现右肾结石3年,伴血尿20 d”于2006年10月入院。专科查体:双肾区不饱满,无压痛及叩击痛;双侧输尿管走行区无压痛。尿常规白细胞(+++)/Hp、红细胞(+++)/Hp,B超提示右肾上极可见一2.3 cm×1.6 cm 大小的强回声光团,无明显声影。IVU提示右肾结石并积水,CT提示右肾上极体积增大,可见一2.5 cm ×2 cm 大小软组织影,CT值为37.6 Hu,略低于周围正常肾实质,增强后轻度强化,但仍低于周围的肾脏实质,周围不光整,与正常组织分界不清。尿细胞学检查未找到恶性细胞。入院诊断:右肾结石合并感染,肾盂癌待排。手术探查见患肾上极皮质变薄,呈囊性感,穿刺抽出少量乳白色液体,于皮质变薄处切开,取出2 cm×2 cm×2 cm 大小褐色结石1枚 ......
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