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目的:提高鹿角形肾结石合并肾盂癌的诊治水平。方法:回顾性分析16例鹿角形肾结石合并肾盂癌患者的临床资料。结果:16例患者中,13例行CT检查,确诊4例;2例行MRI检查,确诊1例。术前确诊的5例患者行根治性肾输尿管切除加膀胱袖状切除。5例分别于开放手术或PCNL术中发现新生物,活检证实后行根治性肾切除加输尿管部分切除。1例行经皮肾镜取石术(PCNL)者后2个月再次手术时发现转移而被迫放弃手术。5例无功能肾者于肾切除术后常规病检发现合并肾盂癌。病理检查证实为鳞状细胞癌12例,移行细胞癌3例,腺癌1例。获随访10例,随访时间1~35个月,死亡7例,术后生存时间1~27个月。结论:鹿角形肾结石合并肾盂癌诊断困难,预后差。对结石病史长、合并感染或肉眼血尿者,术前应考虑合并肾盂癌的可能。CT与MRI检查对诊断鹿角形肾结石合并肾盂癌有重要价值;对术前未确诊而又怀疑结石合并肾盂癌患者,建议行开放手术,勿选PCNL。
Objective: To improve the diagnosis and treatment of deer horn-shaped kidney stones with renal pelvic cancer. Methods: A retrospective analysis of 16 cases of deer angle nephrolithiasis with renal pelvic cancer clinical data. Results: Among the 16 patients, CT was performed in 13 cases and confirmed in 4 cases. MRI was performed in 2 cases and confirmed in 1 case. Five patients diagnosed preoperatively underwent radical nephroureterectomy combined with sleeve resection of the bladder. 5 cases were found in open surgery or PCNL intraoperative new organisms, biopsy confirmed after radical nephrectomy plus ureteral partial resection. 1 case of percutaneous nephrolithotomy (PCNL) were 2 months after re-operation and found that the transfer was forced to give up surgery. Five cases of non-functional nephrectomy in renal pelvis routine examination found associated with renal pelvic cancer. Pathological examination confirmed that 12 cases of squamous cell carcinoma, transitional cell carcinoma in 3 cases, 1 case of adenocarcinoma. All the patients were followed up for 10 months. The follow-up time ranged from 1 to 35 months, 7 died and the postoperative survival time was 1 to 27 months. Conclusion: Stagnant nephrolithiasis with renal pelvic cancer is difficult to diagnose and the prognosis is poor. A long history of stones, with infection or gross hematuria, surgery should be considered before the possibility of renal pelvis cancer. CT and MRI examination for the diagnosis of anthronal kidney stones with pelvic cancer have important value; preoperative undiagnosed and suspected stones with renal pelvis cancer patients, it is recommended to open surgery, do not choose PCNL.