孤立肾肾结石并肾盂肾盏移行细胞癌漏诊分析并文献复习

摘要

目的 探讨孤立肾肾结石并肾盂肾盏移行细胞癌的诊治要点.方法 对我院收治的孤立肾肾结石并肾盂肾盏移行细胞癌1例的临床资料进行回顾性分析,并复习相关文献.结果 本例因右侧腰部隐痛10余年,加重伴肉眼血尿1周入院.10年前诊断为右肾孤立肾肾结石,行右肾切开取石术.1年后结石复发,未诊治.本次入院后行实验室及影像学检查,诊断为右肾孤立肾肾结石,于气管插管全身麻醉下行经皮肾穿刺碎石取石术,术中发现肾中盏单发基底宽1 cm的菜花样肿物.术后病理报告:低级别非浸润性尿路上皮移行细胞癌.与家属商议后行经皮肾镜检查并钬激光消融止血治疗,术中因无法止血,遂行孤立肾切除,术后定期行血液透析治疗.随访7个月,肌酐波动于350～590 μmol/L,腰痛未复发.结论 孤立肾肾结石并肾盂肾盏移行细胞癌临床罕见,易漏诊,且病情复杂,应根据患者自身情况制定个体化治疗方案.%Objective To investigate key points of diagnosis and treatment for solitary kidney patients with renal calculus combined with transitional cell carcinoma of renal pelvis and calices.Methods Clinical data of 1 solitary kidney patient with renal calculus combined with transitional cell carcinoma of renal pelvis and calices was retrospectively analyzed, and related literature was reviewed.Results The patient was admitted for right low back vague pain for more than 10 years and aggravation associated by macrohematuria for 1 week.The patient was diagnosed as having right kidney, solitary kidney and kidney stones 10 years ago, and underwent right kidney of nephrolithotomy.The calculus was recurred 1 year later without being treated.After admission, laboratory and iconography examinations were performed, and the diagnosis of solitary kidney combined with renal calculus was given.Right kidney of percutaneous nephrostolithotomy (PCNL) was performed under tracheal cannula and general anesthesia, and a cauliflower-like solitary neoplasm with 1 cm fundus width was discovered in middle kidney calices, and postoperatively pathological report showed low-grade noninfiltrating uroepithelium transitional cell carcinoma.After the family had agreed, percutaneous nephroscope examination and holmium laser tumor ablation hemostasis were given, but bleeding could not be stopped during operation, and then solitary nephrectomy was performed, and regular hemodialysis treatment was given after operation.With 7 months of follow-up, creatinine level fluctuated at 350-590μmol/L without recurrence of low back pain.Conclusion Solitary kidney patients with renal calculus combined with transitional cell carcinoma of renal pelvis and calices is rare in clinic, and therefore it is easily misdiagnosed.Individualized treatment should be given on the basis of patient''s condition because of complex condition.