肾移植术后并发尿路上皮肿瘤的临床分析  

Clinical analysis of urothelial carcinoma following renal transplantation

作　　者：胡小朋[1] 马麟麟[1] 张小东[1] 王玮[1] 王勇[1] 李晓北[1] 陈晓[1] 

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,100020

出　　处：《中华泌尿外科杂志》2006年第7期493-495,共3页Chinese Journal of Urology

摘　　要：目的分析肾移植患者并发尿路上皮肿瘤的特点,探讨其诊治方法。方法自1998-2003年肾移植患者1293例,术后发生尿路上皮恶性肿瘤21例(1.6%)。男4例,女17例。17例原发病为慢性间质性肾炎。发生尿路上皮肿瘤距肾移植6～62个月,平均26个月。其中膀胱癌6例,单侧肾盂或输尿管癌6例,单侧肾盂或输尿管、膀胱癌8例。双侧。肾盂输尿管癌1例。10例上尿路肿瘤发生部位与移植肾同侧,4例发生于移植肾对侧。临床症状以无痛性肉眼血尿和反复泌尿系感染为主。19例行手术治疗,术后所有患者免疫抑制剂用量减少1/3并辅以局部灌注化疗。结果2例行姑息性治疗的晚期肿瘤患者分别于发现肿瘤5、8个月死亡。余19例现已随访2～5年。13例肿瘤复发,复发部位为膀胱或对侧原肾、输尿管。所有患者在免疫抑制剂减量期间均未出现急性排斥。2例因切除移植肾恢复透析,17例肾功能正常。结论慢性间质性肾炎导致肾功能衰竭的肾移植患者和女性肾移植患者易发生移植后尿路上皮肿瘤；移植肾同侧上尿路较对侧好发肿瘤；对移植肾对侧为首发的上尿路发生肿瘤者可预防性行双侧上尿路根治性切除。Objective To analyze the clinical features of urothelial carcinoma in renal allografi recipients and to investigate its diagnosis and treatment. Methods A retrospective study was undertaken on 1293 renal allograft recipients in our center between 1998 and 2003. Of them ,21 cases（72.4% ） had urothelial carcinoma （4 males and 17 females）. All the cases had not had tumor before transplantation. In 17 cases the protopathy was chronic interstitial nephritis （CIN）. The mean interval between tumorigenesis and transplantation was 26 months （ range,6 - 62 months）. Of the 21 cases,6 had bladder transitional cell carcinoma （TCC） ;6 had unilateral pelvic or ureter TCC ;8 had unilateral pelvic or ureter and bladder TCC;1 had bilateral pelvic and ureter TCC. In 10 cases,the ipsilateral upper urinary tract of the graft was involved; and in 4 cases,the contralateral upper urinary tract was involved. Painless gross hematuria and iterative urinary tract infection were the cardinal symptoms. Surgical treatment was performed in 19 cases. Postoperatively, all the cases received immunosuppressants at one third reduction dose in combination with intravesical instillation chemotherapy. Results Two cases receiving palliative treatment died 5 and 8 months after diagnosis. The other 19 cases were followed for 2 - 5 years. Of them, 13 cases had tumor recurrence. The recurrence sites were bladder and the contralateral upper urinary tract. All the cases had no acute rejection at reduced dose of immunosuppressants, and all had normal renal function except for 2 cases, who underwent removal of the graft and had dialysis again. Conclusions Renal allograft recipients whose protopathy is CIN and female recipients have the risk of urothelial carcinoma after renal transplantation. Urothelial carcinoma occurs more often in ipsilateral upper urinary tract of the graft than in contralateral upper urinary tract. Considering the high possibility of bilateral upper urinary tract involvement by TCC, prophylactic bilateral nephroureterec

关 键 词：肾移植 尿路上皮肿瘤 

分 类 号：R699[医药卫生—泌尿科学] R737.1[医药卫生—外科学]