北京大学学报(医学版) ›› 2023, Vol. 55 ›› Issue (5): 948-952. doi: 10.19723/j.issn.1671-167X.2023.05.027

• 短篇论著 • 上一篇    

经皮肾镜取石术中异常肾盂黏膜活检结果分析

田聪,刘军,杨波,乔佳佳,黄晓波,许清泉*()   

  • 收稿日期:2023-02-22 出版日期:2023-10-18 发布日期:2023-10-09
  • 通讯作者: 许清泉 E-mail:xuqingquan@bjmu.edu.cn
  • 基金资助:
    北京市卫生健康和科技成果适宜技术推广项目(BHTPP2022082)

聪 田,军 刘,波 杨,佳佳 乔,晓波 黄,清泉 许*()   

  • Received:2023-02-22 Online:2023-10-18 Published:2023-10-09
  • Contact: 清泉 许 E-mail:xuqingquan@bjmu.edu.cn
  • Supported by:
    the Beijing Health Technologies Promotion Program(BHTPP2022082)

关键词: 经皮肾镜取石术, 肾盂肿瘤, 肾结石, 活组织检查

中图分类号: 

  • R737.11

表1

接受肾盂黏膜活检患者的临床特征"

Clinical characteristics Male (n=40) Female (n=29)
Urine white blood cell/(/μL), M (P25, P75) 97.50 (26.00, 912.50) 552.00 (85.50, 1 585.50)
Urine red blood cell/(/μL), M (P25, P75) 61.50 (11.25, 397.50) 30.00 (15.00, 80.00)
Urine bacterial count/(/μL), M (P25, P75) 24.00 (8.00, 622.00) 586.00 (46.00, 3 254.00)
Urine pH, M (P25, P75) 6.00 (5.63, 6.88) 6.25 (6.00, 6.50)
Urine nitrite positive, n (%) 6 (15.00) 8 (27.60)
Serum creatinine/(μmol/L), M (P25, P75) 85.00 (73.00, 102.25) 84.00 (59.50, 179.00)
Urine bacterial culture positive, n (%) 8 (20.70) 16 (58.60)
Maximum stone diameter/cm, M (P25, P75) 2.30 (2.00, 3.62) 3.00 (2.00, 4.05)
Degree of hydronephrosis, n (%)
    Mild 9 (22.50) 7 (24.10)
    Moderate 11 (27.50) 7 (24.10)
    Severe 13 (32.50) 11 (37.90)
Ipsilateral surgery, n (%) 8 (20.00) 10 (34.50)
History of stones/months, M (P25, P75) 30.00 (2.00, 120.00) 67.00 (6.75, 177.00)

图1

合并肾盂癌患者的术前CT影像"

表2

肾盂癌患者的临床特征"

Gender Age/ years History of stones/year Degree of hydronephrosis Ipsilateral surgery Urinary infection Stone type Biopsy pathology Treatment Follow-up
Male 65 1 Mild+renal cyst Yes No Multiple Papillary high-grade UTUC Endoscopic resection Male0
Female 40 10 Severe Yes Yes Staghorn High-grade UTUC Neoadjuvant chemotherapy (GC) and RNU Female0
Male 67 20 NA No No Staghorn High-grade UTUC with squamous differentiation Endoscopic ablation and neoadjuvant chemotherapy (GC) Male0
Male 56 3 Severe Yes Yes Multiple Squamous cell carcinoma Renal artery embolization Male0
Male 50 3 Severe Yes Yes Multiple Low-grade UTUC RNU and adjuvant chemotherapy (GC) Male0
Female 68 20 Moderate Yes Yes Staghorn Low-grade UTUC with high grade component Endoscopic resection Female0
Male 58 0.25 Severe No No Multiple Low-grade UTUC with high grade component RNU Male0
Male 79 0.25 Severe+renal cyst Yes Yes Multiple UTUC Renal artery embolization Male0
1 Green DA , Rink M , Xylinas E , et al. Urothelial carcinoma of the bladder and the upper tract: Disparate twins[J]. J Urol, 2013, 189 (4): 1214- 1221.
doi: 10.1016/j.juro.2012.05.079
2 Favaretto RL , Shariat SF , Chade DC , et al. The effect of tumor location on prognosis in patients treated with radical nephrourete-rectomy at Memorial Sloan-Kettering Cancer Center[J]. Eur Urol, 2010, 58 (4): 574- 580.
doi: 10.1016/j.eururo.2010.07.003
3 Geraghty RM , Davis NF , Tzelves L , et al. Best practice in interventional management of urolithiasis: An update from the European Association of Urology Guidelines Panel for Urolithiasis 2022[J]. Eur Urol Focus, 2023, 9 (1): 199- 208.
doi: 10.1016/j.euf.2022.06.014
4 毛厚平, 施祝贤, 江涛, 等. 肾积水程度对微创经皮肾镜取石术效率及结石清除率的影响[J]. 泌尿外科杂志(电子版), 2021, 13 (3): 25- 32.
doi: 10.3969/j.issn.1674-7410.2021.03.007
5 Raghavendran M , Rastogi A , Dubey D , et al. Stones associated renal pelvic malignancies[J]. Indian J Cancer, 2003, 40 (3): 108- 112.
doi: 10.4103/0019-509X.13061
6 Paonessa J , Beck H , Cook S . Squamous cell carcinoma of the renal pelvis associated with kidney stones: A case report[J]. Med Oncol, 2011, 28 (Suppl 1): S392- S394.
7 Xiao J , Lei J , He L , et al. Renal calculus complicated with squamous cell carcinoma of renal pelvis: Report of two cases[J]. Can Urol Assoc J, 2015, 9 (5/6): E310- E312.
8 Hosseinzadeh M , Mohammadzadeh S . Primary pure squamous cell carcinoma of kidney associated with multiple stag horn stones[J]. Int Med Case Rep J, 2020, 13, 261- 263.
doi: 10.2147/IMCRJ.S261022
9 Kasahara R , Kawahara T , Tajiri R , et al. Renal squamous cell carcinoma with staghorn calculus[J]. Case Rep Oncol, 2020, 13 (1): 403- 407.
doi: 10.1159/000506675
10 Sivaramakrishna B , Aron M , Ansari MS , et al. Squamous cell carcinoma of the renal pelvis manifesting after percutaneous nephrolithotomy for long standing calculus[J]. Int Urol Nephrol, 2004, 36 (2): 149- 151.
doi: 10.1023/B:UROL.0000034672.68658.fa
11 仲浩舟, 谢汶桂, 黄玉华, 等. 肾结石合并肾盂癌的诊断和治疗[J]. 现代泌尿生殖肿瘤杂志, 2020, 12 (6): 328- 330.
doi: 10.3870/j.issn.1674-4624.2020.06.003
12 王黎, 姚启盛, 陈从波, 等. 肾结石并肾盂鳞癌六例[J]. 临床外科杂志, 2021, 29 (8): 764- 766.
doi: 10.3969/j.issn.1005-6483.2021.08.020
13 陶维雄, 李辉明, 魏世平, 等. 肾结石合并肾盂鳞状细胞癌4例报告并文献复习[J]. 临床泌尿外科杂志, 2014, 29 (7): 629- 630.
doi: 10.13201/j.issn.1001-1420.2014.07.022
14 van de Pol JAA , van den Brandt PA , Schouten LJ . Kidney stones and the risk of renal cell carcinoma and upper tract urothelial carcinoma: The Netherlands Cohort Study[J]. Br J Cancer, 2019, 120 (3): 368- 374.
doi: 10.1038/s41416-018-0356-7
15 Federico A , Morgillo F , Tuccillo C , et al. Chronic inflammation and oxidative stress in human carcinogenesis[J]. Int J Cancer, 2007, 121 (11): 2381- 2386.
doi: 10.1002/ijc.23192
16 Manganelli A , Barbanti G , Fornaini M , et al. Transitional cell carcinoma of the ureteral stump 13 years after nephrectomy for benign disease[J]. Urol Int, 1996, 56 (1): 52- 54.
doi: 10.1159/000282810
17 王爱香, 畅继武, 张淑敏, 等. 肾源性腺瘤临床病理学分析[J]. 中华泌尿外科杂志, 2011, 32 (3): 185- 188.
doi: 10.3760/cma.j.issn.1000-6702.2011.03.013
18 Nakamoto T , Igawa M , Fukushima M , et al. Fibroepithelial polyp in the renal pelvis[J]. Urol Int, 1996, 56 (1): 48- 51.
doi: 10.1159/000282809
19 叶楠, 古宏兵, 程宗三, 等. 肾结石并发肾盂癌的诊治体会[J]. 国际泌尿系统杂志, 2020, 40 (3): 534- 537.
doi: 10.3760/cma.j.cn431460-20190401-00039
20 Yeh CC , Lin TH , Wu HC , et al. A high association of upper urinary tract transitional cell carcinoma with nonfunctioning kidney caused by stone disease in Taiwan[J]. Urol Int, 2007, 79 (1): 19- 23.
doi: 10.1159/000102907
21 赖斌, 赵勇, 冯峰, 等. 尿脱落细胞的荧光原位杂交技术在尿路上皮癌的临床应用研究[J]. 泌尿外科杂志(电子版), 2020, 12 (2): 31- 36.
doi: 10.3969/j.issn.1674-7410.2020.02.007
22 于潇, 金讯波, 夏庆华, 等. 肾盂癌行输尿管软镜检查的临床意义[J]. 泌尿外科杂志(电子版), 2013, 5 (2): 50- 51.
23 Seisen T , Peyronnet B , Dominguez-Escrig JL , et al. Oncologic outcomes of kidney-sparing surgery versus radical nephroureterectomy for upper tract urothelial carcinoma: A systematic review by the EAU non-muscle invasive bladder cancer guidelines panel[J]. Eur Urol, 2016, 70 (6): 1052- 1068.
doi: 10.1016/j.eururo.2016.07.014
24 Birtle A , Johnson M , Chester J , et al. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): A phase 3, open-label, randomised controlled trial[J]. Lancet, 2020, 395 (10232): 1268- 1277.
doi: 10.1016/S0140-6736(20)30415-3
25 Leow JJ , Chong YL , Chang SL , et al. Neoadjuvant and adjuvant chemotherapy for upper tract urothelial carcinoma: A 2020 syste-matic review and meta-analysis, and future perspectives on syste-mic therapy[J]. Eur Urol, 2021, 79 (5): 635- 654.
doi: 10.1016/j.eururo.2020.07.003
[1] 刘毅,袁昌巍,吴静云,沈棋,肖江喜,赵峥,王霄英,李学松,何志嵩,周利群. 靶向穿刺+6针系统穿刺对PI-RADS 5分患者的前列腺癌诊断效能[J]. 北京大学学报(医学版), 2023, 55(5): 812-817.
[2] 袁昌巍,李德润,李志华,刘毅,山刚志,李学松,周利群. 多参数磁共振成像中动态对比增强状态在诊断PI-RADS 4分前列腺癌中的应用[J]. 北京大学学报(医学版), 2023, 55(5): 838-842.
[3] 郑丹枫,李君禹,李佳曦,张英爽,钟延丰,于淼. 青少年特发性脊柱侧凸椎旁肌的病理特征[J]. 北京大学学报(医学版), 2023, 55(2): 283-291.
[4] 王昱,张慧敏,邓雪蓉,刘伟伟,陈璐,赵宁,张晓慧,宋志博,耿研,季兰岚,王玉,张卓莉. 尿枸橼酸定量检测在原发性痛风患者肾结石诊断中的应用价值[J]. 北京大学学报(医学版), 2022, 54(6): 1134-1140.
[5] 安立哲,熊六林,陈亮,王焕瑞,陈伟男,黄晓波. 腹腔镜肾盂成形术联合肾盂镜超声碎石取石术治疗肾盂输尿管连接部梗阻合并肾结石[J]. 北京大学学报(医学版), 2022, 54(4): 746-750.
[6] 戴翔,左美妮,张晓鹏,胡浩,徐涛. 经皮肾镜术中不同憩室颈部处理方式治疗肾盏憩室结石的长期预后[J]. 北京大学学报(医学版), 2021, 53(4): 704-709.
[7] 郝一昌,颜野,张帆,邱敏,周朗,刘可,卢剑,肖春雷,黄毅,刘承,马潞林. 穿刺活检单针阳性的前列腺癌手术策略选择及经验总结[J]. 北京大学学报(医学版), 2020, 52(4): 625-631.
[8] 王明瑞,王起,胡浩,赖金惠,贺永新,熊杰,刘献辉,刘士军,许克新,徐涛. 标准通道经皮肾镜取石术治疗孤立肾肾结石的长期安全性和有效性[J]. 北京大学学报(医学版), 2020, 52(4): 663-666.
[9] 高健,胡立宝,陈尘,郅新,徐涛. 经皮肾镜去石术后出血的介入治疗[J]. 北京大学学报(医学版), 2020, 52(4): 667-671.
[10] 康宁,蒋一航,蒋宇光,吴栗洋,张际青,牛亦农,张军晖. 内镜联合超声与单纯超声引导建立皮肾通道在多镜联合术中的应用[J]. 北京大学学报(医学版), 2020, 52(4): 692-696.
[11] 朱学华,杨明钰,夏海缀,何为,张智荧,刘余庆,肖春雷,马潞林,卢剑. 机器学习模型在预测肾结石输尿管软镜碎石术后早期结石清除率中的应用[J]. 北京大学学报(医学版), 2019, 51(4): 653-659.
[12] 谌诚,张博,韩文科,林健,王刚,张晓春,宋毅,赵峥,张中元,金杰,虞巍. 超声造影技术引导下经皮肾穿刺应用于经皮肾镜取石术的单中心初步经验[J]. 北京大学学报(医学版), 2017, 49(6): 1071-1075.
[13] 王少刚, 余虓. 经皮肾镜碎石术——日间手术新探索[J]. 北京大学学报(医学版), 2017, 49(5): 753-755.
[14] 张玉祥,蒙学兵,姚林,张崔建,宋刚,蔡林,张争,李学松,龚侃,李淑清,山刚志,何群,杨新宇,何志嵩,周利群. 单中心14年B超引导下经皮肾肿物穿刺活检经验[J]. 北京大学学报(医学版), 2017, 49(4): 617-621.
[15] 马闰卓,邱敏,何为,杨斌,夏海缀,邹达,陆敏,马潞林,卢剑. 输尿管镜活检可协助上尿路尿路上皮癌危险分层[J]. 北京大学学报(医学版), 2017, 49(4): 632-637.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!