泌尿系鳞状细胞癌诊治分析

发布时间：2018-01-29 10:43

本文关键词： 肾鳞状细胞癌肾盂鳞状细胞癌输尿管鳞状细胞癌膀胱鳞状细胞癌泌尿系鳞状细胞癌　出处：《广西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：泌尿系鳞状细胞癌包括上尿路的肾脏和输尿管鳞癌,下尿路的膀胱及尿道鳞癌等,泌尿系鳞癌是一类临床上少见的泌尿系肿瘤,对泌尿系鳞癌的病因、流行病学、临床特点、诊断、治疗、预后情况进行探讨,以提高对该类疾病的认识和诊疗水平。资料和方法：回顾性分析2003年1月至2016年3月在广西医科大学第一附属医院泌尿外科就诊,并符合本次研究预先制定的纳入和排除标准的泌尿系鳞状细胞癌病例资料,总结临床特点、诊疗、生存时间等,并结合文献进行分析和讨论。结果：35例泌尿系统鳞状细胞癌患者中,男性30例,女性5例,年龄31岁-78岁,平均年龄58.2±10.9岁,其中原发性膀胱鳞癌19例,肾鳞癌共14例(病理科报告及出院诊断写明为肾鳞癌8例、肾盂鳞癌6例,两者在本文中统称为肾鳞癌),输尿管鳞癌2例。临床特点方面,泌尿系鳞癌患者常有尿路结石、尿路感染病史,还可有腰痛、下腹痛、膀胱刺激症、排尿困难、肾积水和(或)肾积脓,血尿、肾功能不全等。35例患者均接受手术治疗,手术方式包括肾盂癌根治术(2例)、根治性肾切除术(12例)、输尿管癌根治术(2例)、膀胱部分切除术(4例)、根治性膀胱全切及尿流改道术(10例)、经尿道膀胱肿瘤电切术(2例)、膀胱癌姑息性输尿管皮肤造瘘术(3例)。术后TNM分期发现肿瘤在T2及以上分期、G2及G3分级的患者占大部分。随访时间2月至85月,患者生存时间逐年下降,膀胱鳞癌5年生存率11.8%,肾及输尿管鳞癌5年生存率7.7%,泌尿系鳞癌5年总生存率10%。结论：(1)泌尿系鳞癌临床少见,在≥50岁人群、男性、长期居住在乡村等卫生医疗条件较差地区占比较高。(2)泌尿系长期结石、反复泌尿系感染的患者发生泌尿系鳞癌的风险较高；尤其是肾结石合并长期肾积水或肾积脓者可诱发肾鳞癌。(3)肾鳞癌部分病例缺乏典型的临床表现,常与肾结石并肾积水或肾积脓临床表现重叠,且影像学检查部分病例不提示有典型的肾脏占位性病变,故肾鳞癌早期诊断相对不易,可出现漏诊,术前应提高警惕和预判水平。(4)泌尿系鳞癌恶性程度高、浸润性多、生长迅速、转移早、就诊时多分期较晚,预后差,而肾输尿管鳞癌较膀胱鳞癌的恶性程度更高、预后更差,膀胱鳞癌患者的平均生存时间长于肾输尿管鳞癌。(5)影响泌尿系鳞癌预后的因素有肿瘤N分期、肿瘤分化程度、及手术方式,无淋巴结转移、中-高分化、行根治性手术的患者总平均生存时间较长。(6)本组研究得出泌尿系鳞癌T分期和其预后无统计学显著性差异,提示即使肿瘤分期较晚但在有手术适应症情况下若初诊即选择行根治性切除手术对预后的效果较好,对于T2期及以内的肿瘤行非根治性治疗时一定要掌握好适应症、必要时术后辅助治疗、严密观察随访等。
[Abstract]:Objective: urinary squamous cell carcinoma (USCC) includes upper urinary tract renal and ureteral squamous cell carcinoma, lower urinary tract bladder and urethral squamous cell carcinoma. Urinary squamous cell carcinoma (USCC) is a rare type of urological tumor, which is the etiology of urinary squamous cell carcinoma (USCC). Epidemiology, clinical features, diagnosis, treatment and prognosis were discussed. Data and methods: retrospective analysis was made in urology department of the first affiliated Hospital of Guangxi Medical University from January 2003 to March 2016. In accordance with the pre-established criteria for the inclusion and exclusion of urinary squamous cell carcinoma cases data, summarized clinical characteristics, diagnosis and treatment, survival time, and so on. Results among 35 patients with urinary squamous cell carcinoma, 30 were male and 5 were female, aged from 31 to 78 years, with an average age of 58.2 卤10.9 years. There were 19 cases of primary squamous cell carcinoma of bladder and 14 cases of renal squamous cell carcinoma (8 cases of renal squamous cell carcinoma and 6 cases of renal pelvis squamous cell carcinoma were reported by pathology and discharged from hospital. Both cases were referred to as renal squamous cell carcinoma in this paper). There were 2 cases of ureteral squamous cell carcinoma. In clinical features, urinary tract calculi, urinary tract infection, low back pain, lower abdominal pain, bladder irritation, dysuria, hydronephrosis and / or pyosis were common in patients with squamous carcinoma of the ureter. All the 35 patients with hematuria and renal insufficiency received surgical treatment, including radical resection of renal pelvis carcinoma in 2 cases, radical nephrectomy in 12 cases and radical resection of ureteral carcinoma in 2 cases. Partial cystectomy was performed in 4 cases, radical cystectomy and urinary diversion in 10 cases and transurethral resection of bladder tumor in 2 cases. Palliative ureterostomy was performed in 3 cases of bladder cancer. The majority of patients with G2 and G3 grade were found in TNM staging. The follow-up period was February to 85 months. The survival time of the patients decreased year by year. The 5-year survival rate of bladder squamous cell carcinoma was 11.80.The 5-year survival rate of renal and ureteral squamous cell carcinoma was 7.7%. Conclusion the 5-year overall survival rate of urinary squamous cell carcinoma is 10%. Conclusion: urinary squamous cell carcinoma is rarely seen in clinic. Patients living in rural areas with poor health and medical conditions for a long time accounted for a high percentage of urinary tract long-term stones, and patients with recurrent urinary tract infections had a higher risk of developing urinary squamous cell carcinoma. In particular, renal calculi with long-term hydronephrosis or pyonephrosis can induce renal squamous cell carcinoma. 3) some cases of renal squamous cell carcinoma lack of typical clinical manifestations, and often overlap with renal calculi complicated with hydronephrosis or pyonephrosis. Some of the cases did not show typical renal space-occupying lesions, so the early diagnosis of renal squamous cell carcinoma is relatively difficult, can be missed diagnosis. Preoperative vigilance and predictive level should be raised. (4) squamous cell carcinoma of urinary system has a high degree of malignancy, more infiltration, rapid growth, early metastasis, late staging and poor prognosis. The mean survival time of renal and ureteral squamous cell carcinoma is longer than that of ureteral squamous cell carcinoma. The degree of differentiation of the tumor, and the operation mode, no lymph node metastasis, medium to high differentiation. The total mean survival time of the patients undergoing radical surgery was longer. 6) in this study, there was no significant difference in T stage and prognosis of squamous cell carcinoma of urinary system. It is suggested that radical resection is effective for prognosis even if the tumor stage is late but under the condition of surgical indication. It is necessary to grasp the indication of non-radical therapy for T 2 stage and less tumor, and to observe closely the follow-up and postoperative adjuvant treatment if necessary.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737

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