【摘要】 目的探讨实质浸润型肾盂癌的临床特点、诊治方法及预后,以提高诊疗水平。方法回顾性分析郑州大学第一附属医院2013-06—2018-08间收治的20例实质浸润型肾盂癌的临床资料。其中5例术前诊断为肾癌,4例行肾癌根治术后二期行输尿管残端及膀胱袖套状切除术,1例行肾部分切除术后二期行肾输尿管及膀胱袖套状切除术。15例术前诊断为肾盂癌行肾盂癌根治术(其中1例初诊为慢性肾盂肾炎)。结果 20例中,男12例,女8例;年龄32～80岁。RubensteinⅡ期11例,Ⅲ期5例,Ⅳ期4例。20例均获3～46个月随访,中位随访时间14个月。14例生存,6例死亡。其中4例术前淋巴结及(或)远处转移者术后均行化疗,肿瘤仍进展,分别于术后3个月、5个月、8个月、13个月死于全身多发转移。2例术后于12个月、30个月死于肾盂癌肝、肺转移。结论实质浸润型肾盂癌术前诊断困难,容易误诊,且进展快,易复发转移,疗效及预后差。肿瘤的临床分期和细胞分级仍是影响预后的主要因素。联合应用泌尿系B超、CTU、MRI、输尿管软镜镜检(FU)、尿脱落细胞学荧光原位杂交(FISH)等检查方法,可提高实质浸润型肾盂癌术前正确诊断率,减少术前误诊。手术仍是本病最佳的治疗方法。更多还原

【Abstract】 Objective To investigate the clinical features,diagnosis treatment and prognosia of parenchyma infiltrative renal pelvis carcinoma to improve the level of clinical diagnosis and treatment.Methods The clinical data of 20 cases of prognosia of parenchyma infiltrative renal pelvis carcinoma in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed from June 2013 to August 2018. There are 4 cases of radical nephrectomy and then second underwent distal ureter and bladder resection funnel-shaped,1 case of nrphron-sparing surgery and second underwent kindey ureter and bladder resection funnel-shaped;15 cases underwent kindey rerter and bladder resection funnel-shaped.Results Patients 12 males and 8 females,aged 32-80 years. There are 11 cases of clinical stage Ⅱ,5 cases of stage Ⅲ and 4 cases of stage Ⅳ. All 20 patients were followed up for 3 to 46 months with a median follow-up of 14 months.we found 14 survivors and 6 deaths.4 cases of T4 were given chemotherapy and died of multiple metastases at 3,5,8 and 13 months after surgery. And 2 cases died of liver and lung metastasis at 12 and 30 months after surgery.Conclusion Parenchyma infiltrative renal pelvis carcinoma is difficult to diagnose its nature before surgery,thus results in misdiagnosis,and rapid disease progression,high risk of recurrence and metastasis.Tumor stage and grade are the key point for prognosis.Joint application urinary system ultrasonography,CTU,MRI,FU,FISH to improve its diagnostic accuracy before surgery.Surgery is the preferred treatment progam.更多还原