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目的探讨膀胱癌合并上尿路上皮癌的诊治方法。方法本组膀胱癌合并输尿管癌13例,膀胱癌合并肾盂癌5例。用B超、静脉尿路造影(IVU)、CT、膀胱镜检查及输尿管镜检查进行诊断。对上尿路癌予切除患侧肾及全长输尿管或切除含肿瘤的下段输尿管后行再种术;对膀胱癌行扩大范围的管口周围膀胱切除术,或管口周围+膀胱部分切除术,或管口周围切除+经尿道膀胱肿瘤电切术。结果IVU诊断上尿路梗阻最好,检出率为100%;CT对上尿路癌定位诊断符合率最高(87.5%),膀胱肿瘤诊断符合率为93.75%;膀胱镜发现膀胱癌比率为100%;输尿管镜发现输尿管癌比率为100%。采用各种手术方法均一期完成手术,无明显并发症。术后随访6～24个月,各手术方法间疗效无明显差别。结论多种检查方法相结合有利于减少膀胱癌合并上尿路上皮癌的漏诊率。对该疾病的治疗应根据具体病情采用个体化的方案。
Objective To investigate the diagnosis and treatment of bladder cancer with upper urothelial carcinoma. Methods The group of bladder cancer with ureteral carcinoma in 13 cases, bladder cancer with renal pelvic cancer in 5 cases. B ultrasound, intravenous urography (IVU), CT, cystoscopy and ureteroscopy diagnosis. To upper urinary tract cancer to remove the affected side of the kidney and the full-length ureter or resection of the lower ureter with tumor replantation; for bladder cancer to expand the scope of the oropharyngeal cystectomy, or around the mouth + bladder partial resection , Or around the orifice + transurethral resection of the bladder tumor. Results The diagnosis of upper urinary tract obstruction by IVU was the best, the detection rate was 100%. The coincidence rate of CT diagnosis of upper urinary tract carcinoma was the highest (87.5%) and the coincidence rate of bladder tumor was 93.75% %; Ureteroscopy found ureteral cancer rate was 100%. A variety of surgical methods were completed surgery, no significant complications. After 6 to 24 months of follow-up, there was no significant difference between the operative methods. Conclusion The combination of multiple examinations is helpful to reduce the misdiagnosis rate of bladder cancer with upper urothelial carcinoma. The treatment of the disease should be based on the specific conditions of individual programs.