吴杰英 郭月飞 罗云 方友强 李茂胤 王华 狄金明

【摘要】 血尿以及影像学上明确的肾盂占位性病变是肾盂癌的典型特征，但部分肾盂癌患者临床症状或影像学表现不典型，肾盂癌被误诊为肾癌或被延诊的情况时有报道。该文报道了3例在外院误诊或延迟诊断的肾盂癌患者，通过总结3例患者的临床症状、实验室检查、影像学检查及有创操作检查的结果，分析其临床特点，为肾盂癌的正确、及时诊断提供思路。该文提示，反复无痛性肉眼血尿是肾盂癌的典型症状，对反复血尿的中老年患者，应警惕肾盂癌的可能。笔者提倡在CT、MRI等影像学基础上，配合尿脱落细胞、尿荧光原位杂交技术等无创检查，选择性应用输尿管软镜检查，使肾盂癌患者有机会获得及时、准确的诊断。

【关键词】肾盂癌;误诊;延迟诊断;尿脱落细胞;荧光原位杂交技术;输尿管软镜

【Abstract】 Hematuria and the occupying lesions of renal pelvis confirmed by imaging examination are the typical features of renal pelvic carcinoma. Nevertheless，certain renal pelvic carcinoma patients have been misdiagnosed with renal carcinoma or delayed diagnosis due to nonspecific clinical symptoms or imaging findings. In this paper，three patients of renal pelvic carcinoma who were misdiagnosed or delayed diagnosis in other local hospitals were reported. Clinical symptoms，laboratory examination，imaging examination and invasive procedure outcomes of these three cases were summarized to analyze the clinical characteristics and provide ideas for accurate and timely diagnosis of renal pelvic carcinoma. This article prompted that recurrent painless hematuria is a typical symptom of renal pelvic carcinoma. The possibility of renal pelvic carcinoma should be considered for the middle?aged and elderly patients with recurrent painless hematuria. Based on CT，MRI and other imaging techniques，urine cytology，urine FISH and alternative non?invasive examinations are recommended and flexible ureteroscopy can be performed as necessary to deliver timely and precise diagnosis of renal pelvic carcinoma.

【Key words】 Renal pelvic carcinoma;Misdiagnosis;Delayed diagnosis;Urine cytology;Fluorescence in situ hybridization;Flexible ureteroscopy

肾盂癌是起源于尿路上皮的恶性肿瘤，好发于中老年人，发病率占肾肿瘤的6%～l0%，在肾脏肿瘤中居第2位，仅次于肾癌。肾盂癌中90%为移行细胞癌，8%为鳞状上皮癌，而腺癌不到1%[1]。由于肾盂癌与肾癌等肾实质肿瘤的手术方式不同，当肾盂癌被误诊或延迟诊断时，容易选择不恰当的术式或没有得到及时处理，不仅增加患者负担，也影响疾病预后。我们总结了2013年1月至2018年6月收治的被外院误诊或延迟诊断的3例肾盂癌患者的病例特点，以提高肾盂癌的及时诊断率，报道如下。

病例资料

病例1患者男，69岁。因“反复肉眼血尿4月余”于2018年7月26日到我院就诊。……