本文關鍵詞： 腎鱗狀細胞癌 腎盂鱗狀細胞癌 輸尿管鱗狀細胞癌膀胱鱗狀細胞癌 泌尿系鱗狀細胞癌　出處：《廣西醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的：泌尿系鱗狀細胞癌包括上尿路的腎臟和輸尿管鱗癌,下尿路的膀胱及尿道鱗癌等,泌尿系鱗癌是一類臨床上少見的泌尿系腫瘤,對泌尿系鱗癌的病因、流行病學、臨床特點、診斷、治療、預后情況進行探討,以提高對該類疾病的認識和診療水平。資料和方法：回顧性分析2003年1月至2016年3月在廣西醫(yī)科大學第一附屬醫(yī)院泌尿外科就診,并符合本次研究預先制定的納入和排除標準的泌尿系鱗狀細胞癌病例資料,總結(jié)臨床特點、診療、生存時間等,并結(jié)合文獻進行分析和討論。結(jié)果：35例泌尿系統(tǒng)鱗狀細胞癌患者中,男性30例,女性5例,年齡31歲-78歲,平均年齡58.2±10.9歲,其中原發(fā)性膀胱鱗癌19例,腎鱗癌共14例(病理科報告及出院診斷寫明為腎鱗癌8例、腎盂鱗癌6例,兩者在本文中統(tǒng)稱為腎鱗癌),輸尿管鱗癌2例。臨床特點方面,泌尿系鱗癌患者常有尿路結(jié)石、尿路感染病史,還可有腰痛、下腹痛、膀胱刺激癥、排尿困難、腎積水和(或)腎積膿,血尿、腎功能不全等。35例患者均接受手術治療,手術方式包括腎盂癌根治術(2例)、根治性腎切除術(12例)、輸尿管癌根治術(2例)、膀胱部分切除術(4例)、根治性膀胱全切及尿流改道術(10例)、經(jīng)尿道膀胱腫瘤電切術(2例)、膀胱癌姑息性輸尿管皮膚造瘺術(3例)。術后TNM分期發(fā)現(xiàn)腫瘤在T2及以上分期、G2及G3分級的患者占大部分。隨訪時間2月至85月,患者生存時間逐年下降,膀胱鱗癌5年生存率11.8%,腎及輸尿管鱗癌5年生存率7.7%,泌尿系鱗癌5年總生存率10%。結(jié)論：(1)泌尿系鱗癌臨床少見,在≥50歲人群、男性、長期居住在鄉(xiāng)村等衛(wèi)生醫(yī)療條件較差地區(qū)占比較高。(2)泌尿系長期結(jié)石、反復泌尿系感染的患者發(fā)生泌尿系鱗癌的風險較高；尤其是腎結(jié)石合并長期腎積水或腎積膿者可誘發(fā)腎鱗癌。(3)腎鱗癌部分病例缺乏典型的臨床表現(xiàn),常與腎結(jié)石并腎積水或腎積膿臨床表現(xiàn)重疊,且影像學檢查部分病例不提示有典型的腎臟占位性病變,故腎鱗癌早期診斷相對不易,可出現(xiàn)漏診,術前應提高警惕和預判水平。(4)泌尿系鱗癌惡性程度高、浸潤性多、生長迅速、轉(zhuǎn)移早、就診時多分期較晚,預后差,而腎輸尿管鱗癌較膀胱鱗癌的惡性程度更高、預后更差,膀胱鱗癌患者的平均生存時間長于腎輸尿管鱗癌。(5)影響泌尿系鱗癌預后的因素有腫瘤N分期、腫瘤分化程度、及手術方式,無淋巴結(jié)轉(zhuǎn)移、中-高分化、行根治性手術的患者總平均生存時間較長。(6)本組研究得出泌尿系鱗癌T分期和其預后無統(tǒng)計學顯著性差異,提示即使腫瘤分期較晚但在有手術適應癥情況下若初診即選擇行根治性切除手術對預后的效果較好,對于T2期及以內(nèi)的腫瘤行非根治性治療時一定要掌握好適應癥、必要時術后輔助治療、嚴密觀察隨訪等。
[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 鹵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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R737

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