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目的:探讨肾结石伴积水合并肾盂肿瘤患者的诊断、治疗和随访。方法:分析北京大学人民医院2011年3月至2014年3月期间肾结石积水合并肾盂肿瘤5例患者的临床资料及其诊治经过。结果:5例患者在结石术前均未发现合并肾盂肿瘤。3例在肾结石术中行肾盂黏膜活检确诊肾盂癌;1例术后经影像学复查确诊;1例因感染症状行肾盂血肿清除术,通过肾盂黏膜活检确诊。5例患者中,肾盂癌根治术1例,肾盂肿瘤电灼术1例,肾动脉栓塞术2例,另1例因肿瘤晚期失去手术机会而放弃治疗。行手术治疗的4例患者术后随访至2014年3月,行肾盂癌根治术和肾盂肿瘤电灼术的2例患者未见肿瘤进展;行肾动脉栓塞术的2例患者,1例因出现新的肿物影再次行肾动脉栓塞术,另1例患者于栓塞术后2周复查发现肿瘤略增大。结论:肾结石积水合并肾盂肿瘤患者临床较为隐匿,容易漏诊;解除梗阻、肾脏血供改善后肾盂肿瘤往往进展迅速,对此类患者的早期诊断、积极干预和严密随访非常必要。
OBJECTIVE: To investigate the diagnosis, treatment and follow-up of patients with renal calculi complicated with pyelic tumors. Methods: The clinical data of Peking Union Medical College Hospital from March 2011 to March 2014 in patients with hydronephrosis and renal pelvis tumors were analyzed. Results: All the 5 patients had no tumor of renal pelvis before operation. Three cases were diagnosed renal pelvic cancer by renal pelvic mucosa biopsy in renal calculus. One case was diagnosed by imaging examination and one case was diagnosed as renal pelvis hematoma due to infection symptoms. In 5 patients, radical nephroureterectomy was performed in 1 case, renal pelvis tumor in 1 case, renal artery embolization in 2 cases, and the other one was abandoned due to the chance of losing the operation in the late stage of the tumor. Four patients undergoing surgical treatment were followed up until March 2014. No tumor was found in 2 patients who underwent radical nephroureterectomy and renal pelvis tumor cautery. Two patients who underwent renal artery embolization, New tumor re-Renal artery embolization, and the other 1 patient in 2 weeks after embolization found that the tumor slightly increased. Conclusions: The patients with hydronephrosis and renal pelvis tumor are relatively obscure and easily missed by diagnosis. Renal pelvis tumors are often rapidly progressing after the obstruction and renal blood supply are improved. It is very necessary for early diagnosis, active intervention and close follow-up of such patients.