左肾膀胱重复癌并多囊肾1例报告及文献复习

左肾膀胱重复癌并多囊肾1例报告及文献复习

发表时间：2015-12-23T16:16:55.760Z 来源：《航空军医》2015年11期供稿作者：骆科兵赵泽驹（通讯作者）张能

[导读] 新疆医科大学中医学院分析探讨针灸对关节炎大鼠的镇痛作用，为临床的研究方向提供参考。

遵义医学院附属医院贵州遵义市 563003

【摘要】目的探讨肾膀胱重复癌并多囊肾的诊治策略和程序。方法分析1例我院经治的肾、膀胱重癌并多囊肾临床特点、诊断及治疗过程，结合文献报道，总结类似病例的诊治经验。结果本病完成术前评估后行开放性左肾部分切除术，术后病理诊断为多房性肾细胞癌，监测肾功能Crea124umol/L。2周后恢复良好，行根治性膀胱全切+回肠袋膀胱术，病理诊断为膀胱浸润性尿路上皮癌2级，肿瘤组织累及浅肌层；术后患者新膀胱腹壁造瘘口愈合良好，拔出双侧输尿管支架管后无腰痛、发热等不适。患者膀胱癌手术后10天出院。结论肾膀胱重复癌并多囊肾时选择肾部分切除术，若肾功能稳定可二期行膀胱癌手术。

【关键词】重复癌；肾癌；膀胱癌；多囊肾

【Abstract】Objective To explore the diagnosis and treatment of policies and procedures of the kidney bladder repeated carcinoma with polycystic kidney.Methods Analysising clinical characteristics，diagnosis and the treatment process of 1 case kidney bladder repeated carcinoma with polycystic kidney cured in our hospital，on the basis of the literature，sum up the experiences of diagnosis and treatment of similar cases.Result We would open partial resection of left kidney after completing preoperative assessment.Postoperative pathological diagnosis showed the Multilocular renal cell carcinoma，postoperative kidney Crea was 124umol/L.The patient recovered well after two weeks，performing radical bladder full cutileal pouch bladder surgery.Postoperative pathological diagnosis showed invasive bladder urothelial carcinoma，which showed the muscular tumor involving the shallow.Postoperatively，the new bladder abdominal fistula healed well，and after pulling out bilateral ureteral stent patients had no low back pain，fever and discomfort.Patients discharged from hospital ten days after the completion of bladder cancer surgery.Consideration The patients suffering from the kidney bladder repeated carcinoma with polycystic kidney could choose the renal resection，if renal function is stable，who can choose second stage bladder cancer surgery.

【Key words】Repeated carcinoma；Kidney cancer；Bladder cancer；Polycystic kidney

同一机体同时或先后发生的两种或两种以上的恶性肿瘤，并可排除复发或转移者称为重复癌[1-9]。临床上肾膀胱重复癌少见，现报告1例单侧肾细胞癌及膀胱移行细胞癌合并多囊肾病史特点、诊治过程及转归情况，结合文献对相似疾病的诊治进行总结。

一、临床资料

患者男性，67岁，因“间断无痛性肉眼血尿伴左侧腰痛8月”入院。10月前行左肾结石PCNL术，有多囊肾家族病史。查体：双肾区叩击痛，左侧明显，膀胱区稍压痛。泌尿系USB：双肾结石并左肾积水，膀胱占位性病变。腹部CT：膀胱癌、左肾癌，双肾多发囊肿；肝内多发囊肿。膀胱镜：颈口12、3、7点肿瘤侵犯，顶、后壁多发珊瑚样赘生物，最大约2cm×1.5cm；组织活检：（膀胱）低级别浸润性尿路上皮癌。肾功能：Crea117mmol/L。术前CT及病理结果见附图1.

附图1

1-A 左肾癌CT表现 1-B 膀胱癌CT表现 1-C 膀胱癌术前活检

二、诊疗经过

结合患者有多囊肾家族史、左肾PCNL史及CT、膀胱镜及术前膀胱活检，考虑左肾膀胱重复癌合并多囊肾；但肾功不全，年龄较大，为避免术后肾功能恶化，先行开放左肾部分切除术，术后CRea 124mmol/L，术后2周病情恢复好，行根治性膀胱全切+回肠袋膀胱术，膀胱癌术后一周康复出院。术中资料见附图2.

附图2

图2-A 左肾肿瘤并多发小囊肿图2-B 膀胱多发肿瘤

三、组织病理结果

左肾肿瘤术后病检：左肾多房性肾细胞癌：左肾组织内多个囊肿形成，囊壁见透明状的异性细胞呈实性片状分布，核仁清楚。膀胱肿瘤术后病检：左侧壁、顶壁浸润性尿路上皮癌2级，肿瘤组织累及膀胱浅肌层、前列腺切缘，双侧输尿管断端未见肿瘤累及。术后病理结果