目的:探讨肾实质浸润型尿路上皮癌的临床特点.方法:回顾性分析自2011年12月~2015年5月收治14例肾实质浸润型肾盂癌患者的临床资料,讨论肾实质浸润型尿路上皮癌的特点,并对患者进行随访.结果:14例患者中9例术前确诊肾盂肿瘤,3例误诊为肾实质肿瘤,1例误诊为黄色肉芽肿性肾盂肾炎,1例在根治性膀胱全切手术中发现输尿管原位癌,术后病理证实有肾实质浸润型肾盂癌.13例患者接受手术治疗,术后病理高级别尿路上皮癌12例,其中1例伴鳞状分化,低级别尿路上皮癌1例,1例放弃手术.随访时间5~47个月,其中9例因肿瘤进展死亡.结论:肾实质浸润型尿路上皮癌影像学表现不典型,易被误诊为肾实质肿瘤或炎症,不能除外肾盂癌时,应结合术中冷冻病理检查结果决定手术方式.该病恶性程度高,预后差.%Objective:To discuss the clinical characteristics of urothelical carcinoma with renal parenchyma spread,and reduce misdiagnosis.Methods:The clinical data of 14 cases of uothelical carcinoma with renal parenchyma spread in our department from December 2011 to May 2015 were retrospectively analyzed,and the clinical characteristics of the uothelical carcinoma with renal parenchyma spread were discussed.All patients were followed up.Results:Of the 14 cases,there were 9 cases of renal pelvis tumors clearly diagnosed preoperatively,3 cases of middiagnosed renal parenchymal neoplasms,1 case of middiagnosed xanthogranulomatous pyelonephritis,and one case of ureter carcinoma in situ that was proved as urothelical carcinoma with renal parenchyma spread by postoperative pathology during radical total cystectomy.In 13 cases receiving surgical treatments,there were 12 cases of high-level urothelical carcinoma (including one case of squamous metaplasia),and 1 case of low-level urothelical carcinoma.One case gave up surgical treatment.During the follow-up period of 5 to 47 months,9 cases died because of tumor progression.Conclusions:Imaging of urothelical carcinoma with renal parenchyma spread is atypical and it is easy to be diagnosed as renal parenchymal neoplasms or inflammation.If urothelical carcinoma cannot be excluded,frozen section during operation is useful.Urothelical carcinoma with renal parenchyma spread has high degree of malignancy and its prognosis is poorer.
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