肾移植术后并发泌尿系统肿瘤的相关因素与临床干预  

Analysis of malignancies in the urinary system after renal transplantation (Report of 10 times in 9 cases)

作　　者：杨志豪[1] 张冠[1] 彭明强[1] 周晓峰[1] 方自林[1] 冯照晗[1] 刘乃波[1] 王翔[1] 张钊[1] 

机构地区：[1]中日友好医院泌尿外科,北京100029

出　　处：《临床泌尿外科杂志》2008年第1期13-15,共3页Journal of Clinical Urology

摘　　要：目的：探讨肾移植术后并发泌尿系统肿瘤的相关因素与临床干预措施。方法：报告9例（10次）此种患者的临床资料。9例肾移植术后均行免疫抑制治疗。肿瘤均发生在自体肾、输尿管和膀胱：肾透明细胞癌、肾肉瘤和膀胱腺癌各1例，肾盂输尿管膀胱移行细胞癌6例，其中1例先发生膀胱腺癌后又发生肾盂输尿管移行细胞癌。肿瘤发生于移植术后8～146个月，且8例发生在应用新型免疫抑制剂之后。患者均有服用龙胆泻肝丸或冠心苏合丸史。8例接受了根治性手术，1例未能手术切除。结果：9例随访8～44个月，未能手术切除1例于术后5个月肝转移死亡。1例肉瘤复发后放弃治疗后死亡。1例膀胱肿瘤复发，行膀胱全切腹壁造瘘术，1例腺癌已出现肺和胸膜转移。另5例最后随访时存活良好。结论：肾移植术后并发泌尿系统肿瘤以移行细胞癌为多；可能与服用含马兜铃的中药和应用新型免疫抑制剂有关；根治性手术治疗、减少免疫抑制剂用量和更换免疫抑制剂种类是主要临床干预措施。Objective： To study the incidence and clinical feature of malignancies in the urinary system in renal transplantation recipients. Methods： A retrospective study of 10 malignancies in the urinary system after renal transplantation in 9 cases was carried out. Results： All tumors occured in their own kidney, ureter or bladder. There were 1 clear-cell carcinoma of renal, 1 nephrosarcoma,2 transitional cell carcinoma of renal pelvis,3 transitional cell carcinoma of bladder, 2 transitional cell carcinoma in both renal pelvis and ureter, 1 no pathology report. Nine cases of malignancies in the urinary system occurred during 8 to 126 months after renal transplantation. They all underwent the application of the traditional Chinese medicine contain of aristolochic acid. The urologic malignant tumor of post- transplantation was found after applying new immunosuppressive agent. Renal function was normal in 6 patients, abnormal in 3. The treatment included surgery and chemical therapy, with decreased dose of immunosuppressive agents. Eight cases underwent radical surgery. Conclusions：Malignancies in the urinary system after renal transplantation should be alert. The risk factors may includ using the traditional Chinese medicine contain of aristolochic acid and applying new immunosuppressive agent.

关 键 词：肾移植 泌尿系统肿瘤 马兜铃酸 

分 类 号：R737.0[医药卫生—肿瘤]