Kiriyama I, Ueno M, Amemiya H, Muramatsu H, Tsuchida H, Matsuse K, Toyoshima A, Yazaki T, Waku M
Department of Urology, Teikyo University School of Medicine.
Hinyokika Kiyo. 1987 Sep;33(9):1423-6.
We report a case of multiple urothelial tumors (left renal pelvis, ureter and bladder) with chronic renal failure in a 72-year-old man. The patient was admitted because of gross hematuria with increasing volume and intervals on September 14, 1985. Admission evaluation including excretory urography, retrograde pyelography, computed tomography and cystoscopy revealed multiple urothelial tumors in the left renal pelvis, ureter and bladder. Radical surgery, however, was postponed because of pneumothorax induced by an inadvertent insertion of the CVP catheter at operation. Subsequent respiratory disturbance persisted so that he was observed at the outpatient clinic following right ureterocutaneostomy. Gradual increase in anemia and decrease in renal function, however, prompted another admission. Gross hematuria necessitating frequent blood replacement could not be controlled by transurethral resection of bladder tumors. Therefore left nephroureterectomy with resection of bladder cuff was performed after internal arteriovenous shunt had been established, because favorable results regarding tumor resection were obtained from preoperative evaluations. He showed satisfactory recovery and was spared hemodialysis despite eventful postoperative course with transient decrease in renal function. The patient was discharged on 130th postoperative day and is now being followed up at the outpatient clinic. The relevant literature is also reviewed briefly.
我们报告一例72岁男性患有多发尿路上皮肿瘤（左肾盂、输尿管和膀胱）并伴有慢性肾衰竭。该患者因肉眼血尿且出血量和发作间隔增加于1985年9月14日入院。入院评估包括排泄性尿路造影、逆行肾盂造影、计算机断层扫描和膀胱镜检查，结果显示左肾盂、输尿管和膀胱存在多发尿路上皮肿瘤。然而，由于手术中意外插入中心静脉压导管导致气胸，根治性手术被推迟。随后呼吸障碍持续存在，因此在右输尿管皮肤造口术后在门诊进行观察。然而，贫血逐渐加重和肾功能下降促使再次入院。经尿道膀胱肿瘤切除术无法控制需要频繁输血的肉眼血尿。因此，在建立体内动静脉分流后，进行了左肾输尿管切除术并切除膀胱袖口，因为术前评估显示肿瘤切除效果良好。尽管术后过程波折，肾功能出现短暂下降，但他恢复良好，无需进行血液透析。患者于术后第130天出院，目前在门诊接受随访。同时也简要回顾了相关文献。
