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目的探讨肾实质浸润为主的肾盂尿路上皮癌的诊断治疗。方法回顾8例肾实质浸润型尿路上皮癌患者临床资料。男6例,女2例。43~78岁,平均64岁;左侧3例,右侧5例。肿瘤直径3.0~8.5 cm,平均5.2 cm。TNM分期为Ⅲ期2例,Ⅳ期6例,G2级2例,G3级6例。结果 8例患者均行手术治疗,肾输尿管全切+膀胱部分切除术4例,肾切除术4例,且1例行肾上腺切除+腔静脉取瘤栓术。术后病理均为尿路细胞癌,伴鳞状分化2例。侵犯肾包膜或肾周脂肪6例,肾门淋巴结转移4例,输尿管浸润3例,下腔静脉癌栓并同侧肾上腺转移1例,合并膀胱癌1例。8例均获随访,随访时间3个月~4年,6例死亡,平均存活9个月;另2例分别存活13个月及4年。结论肾实质浸润型尿路上皮癌早期影像学诊断困难,易发生浸润及转移,预后差。积极的手术探查对明确诊断、争取更好预后有重要意义。
Objective To investigate the diagnosis and treatment of renal pelvic urothelial carcinoma with renal parenchymal infiltration. Methods The clinical data of 8 cases of renal parenchymal invasive urothelial carcinoma were retrospectively reviewed. 6 males and 2 females. 43 to 78 years old, average 64 years old; left 3 cases, right 5 cases. Tumor diameter 3.0 ~ 8.5 cm, an average of 5.2 cm. There were 2 cases with stage III TNM, 6 cases with stage IV, 2 cases with G2 stage and 6 cases with G3 stage. Results All the 8 patients underwent surgical treatment, 4 cases underwent partial ureterorectal excision + partial nephrectomy, 4 cases underwent nephrectomy and 1 case received adrenalectomy + vena cava tumor embolization. Postoperative pathology is urinary cell carcinoma, with squamous differentiation in 2 cases. Invasion of the renal capsule or perirenal fat in 6 cases, 4 cases of renal cell lymph node metastasis, ureter invasion in 3 cases, inferior vena cava tumor thrombus and ipsilateral adrenal metastasis in 1 case, with bladder cancer in 1 case. All patients were followed up for 3 months to 4 years. Six patients died, with an average survival of 9 months. The other two patients survived for 13 months and 4 years respectively. Conclusion Renal parenchymal infiltration of urothelial carcinoma early imaging diagnosis difficult, prone to infiltration and metastasis, the prognosis is poor. Positive surgical exploration of a clear diagnosis, strive for a better prognosis of great significance.