| Objective:To provide epidemiological data for the development of standardized prevention and treatment measures to reduce the incidence of urinary tract tumors in MHD patients,and to provide a reference to develops diagnosis and treatment plan for MHD with urinary tumors for clinicians,By analyzing the clinical characteristics,diagnosis and treatment experience,prognosis and laboratory indicators of MHD patients with urinary tract tumors in Chengde.Methods:1 From the database of our medical records browsing system in our hospital,we selected patients who were admitted to our hospital for nephrology and urology from January 2013 to December 2018.Their primary or secondary diagnosis was chronic kidney disease stage 5 or uremia Stage or end-stage renal disease or renal failure or dialysis status.The tumor occurrence,clinical diagnosis and treatment,and prognosis of patients with MHD and urinary tumors were analyzed.2 Patients with urinary tumors were selected from MHD patients who meet the inclusion criteria.Calculate the reference range of their age at the time of tumor occurrence,and select 200 non-tumor patients from the MHD patients who meet the inclusion criteria.Their age is within the age reference range of patients with MHD and urinary tumors.The laboratory indicators of the two groups were compared,and the relevant factors that affected urinary tumors in MHD patients were obtained by binary logistic regression analysis.Results:1 Among 912 patients with MHD,22 had urinary tumors.The incidence of urinary tumors was 2.41%.When tumors occurred,the average age was(66.23±10.01)years.Causes of renal failure: 11(50%)cases of hypertensive nephropathy,4(18.2%)cases of long-term medication history,and drugs are "Guanmutong,Longdanxiegan Pill,Guanxin Suhe Pill".2(9.1%)cases of diabetic nephropathy,1(4.5%)cases of double kidney cast stones,1(4.5%)cases of bladder neck obstruction after left renal tuberculosis,2(9%)cases of chronic nephritis,bilateral Ureteral calculi caused 1(4.5%)cases of acute postrenal obstruction.Among them,12 were bladder tumors(54.5%),3 were pelvic tumors(13.6%),5 were ureteral tumors(22.7%),and 2 were renal tumors(9.1%).There were 17(77.3%)cases of intermittent hematuria or bloody urethral discharge,3(13.6%)cases of continuous gross hematuria,1(4.5%)cases of back pain,and 1(4.5%)cases of abdominal pain and urination.2 10 patients with MHD and urinary tumors underwent surgical treatment,with a recurrence rate of 50%,8 patients underwent local tumor resection,and 6(75%)relapsed after surgery;Among the 10 patients,8 had high-grade urothelial carcinoma and 2 had papilloma.12 patients chose conservative treatment,2 of which could not be surgically treated due to tumor metastasis,and 10 patients could not be surgically treated due to combined disease or economic reasons.4 of the surgical patients had died,and 3(75%)of the deaths were due to cardiovascular disease,and 1(25%)were due to tumor recurrence and metastasis;9 of the non-operative patients had died,and 4(44.4%)of the causes of death were In cardiovascular disease,3(33.3%)cases were severe anemia combined infection caused by tumor,and 2(22.2%)cases were tumor metastasis;6 of 10 surgical patients survived so far with a survival time of 12?36 months,the average survival time was(22.5±8.09)months;the survival time of the 4 patients who died was 27?50 months,The average survival time was(42.25±10.47)months.3 of 12 non-surgical patients have survived so far,and the survival time is 9?12 months,the average survival time is(10.33±1.53)months;The survival time of 9 death patients is 6?24 months,the average survival time was(13.22±5.52)months.The survival time of non-surgical patients was significantly lower than that of surgical patients,and the difference was statistically significant(P <0.05).3 Binary Logistic regression analysis was performed on the two groups of observation indicators.The results were: urea nitrogen before the first dialysis(OR = 1.095,95% CI: 1.035-1.158),dialysis age(OR=1.019,95% CI: 1.004-1.033),Creatinine before the first dialysis(OR=1.001,95% CI: 0.999-1.004),hemoglobin during the dialysis(OR=0.902,95% CI: 0.846-0.962),albumin during the dialysis(OR = 0.757,95% CI: 0.622-0.920)P values were less than 0.05,and the P values of hemoglobin before the first dialysis and bicarbonate before the first dialysis were greater than 0.05;suggesting that dialysis age,urea nitrogen before the first dialysis,and creatinine before the first dialysis were risk factors for MHD with urinary tumor,Hemoglobin and albumin during dialysis are protective factors for MHD combined with urinary tumors,while hemoglobin before first dialysis and bicarbonate before first dialysis are not related to whether MHD patients have urinary tumors.Conclusion:1 Dialysis age,urea nitrogen before the first dialysis,and creatinine before the first dialysis are risk factors for MHD patients with urinary tumors.Hemoglobin during dialysis and albumin during dialysis are protective factors for MHD patients with urinary tumors.2 Surgical treatment of MHD patients with urinary tumors can prolong survival significantly if the general conditions permit.3 MHD Patients with urinary tumors undergo local tumor resection,the recurrence rate is higher. |
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