马兜铃酸肾病肾移植术后泌尿系统并发尿路上皮癌8例临床分析  

Clinical analysis of eight cases of carcinoma of urinary system after renal transplantation for aristolochic acid nephropathy

作　　者：肖龙仁[1] 杨亦荣[1] 夏鹏[1] 郑少玲[1] 陈琰[1] 沈龙捷[1] 

机构地区：[1]温州医学院附属第一医院移植中心,浙江温州325000

出　　处：《解放军医学杂志》2010年第4期442-444,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的总结马兜铃酸肾病(AAN)患者肾移植术后泌尿系统并发恶性肿瘤的临床特点及治疗体会。方法回顾分析2000年3月-2009年10月,28例AAN终末期肾功能衰竭患者同种异体肾移植术后泌尿系统并发恶性肿瘤发病特点、治疗及预后情况。28例AAN患者肾移植术后并发尿路上皮癌8例(28.6%),肿瘤均发生于受者自体泌尿系统,男4例,女4例,年龄35～68岁,平均52岁,患者移植术前均有明确AAN病史,均行血液透析治疗。发现肿瘤距移植时间为11～72个月,平均31个月。以反复发作全程肉眼血尿为首发症状者7例,体检偶然发现1例。病理结果均为尿路上皮癌,其中膀胱癌4例,左肾盂及双侧输尿管癌1例,双侧输尿管及膀胱癌1例,右肾盂输尿管癌1例,右肾盂及膀胱癌1例。患者均行手术治疗,肿瘤切除术后更换免疫抑制方案。对于膀胱癌患者术后予重组人α-2b干扰素+表阿霉素膀胱灌注化疗。结果本组8例患者手术顺利,术后肿瘤复发率为62.5%(5/8),术后随访8～72个月,平均32个月。除1例因发生移植肾急性排斥反应,移植肾切除后恢复血液透析,1例因移植肾功能减退恢复血液透析,后死于脑栓塞,其余6例肾功能正常,随访至今。结论ANN患者肾移植术后自体泌尿系统并发尿路上皮癌发病率高,且肿瘤呈多发性,复发率高。对发生尿路上皮癌的患者,在切除肿瘤的同时,应行双侧上尿路根治性切除术。Objective To summarize the incidence and clinical characteristics of urinary system carcinoma （UC） in the patients receiving renal transplantation for aristolochic acid nephropathy （AAN）.Methods The clinical characteristics,therapy and prognosis of complicated malignant tumor after renal transplantation were retrospectively analyzed in 28 patients,who were admitted from Mar.2000 to Oct 2009 for allogenic renal transplantation on account of AAN terminal stage renal failure.Of the 28 patients,8 （4 males and 4 females,aged from35 to 68 with an average of 52） were found to have UC postoperatively.The mean interval from transplantation to discovery of UC was 31 months （range 11-72months）.The recurrent attacks of macroscopic haematuria was the first symptom in 7 cases,and in the other patient it was accidentally discovered in physical examination.Of the 8 cases,carcinoma of bladder accounted for 4 cases,tumor occurred in left pelvis and bilateral ureters in 1 case,in bilateral ureters and bladder in 1 case,in right pelvis and right ureter in 1 case,and in right pelvis and bladder in 1 case.Surgical treatment was performed in all the cases and the immunosuppressive regimen was changed after operation.Intravesical chemotherapy with recombinant human interferon α-2b＋ epirubicin was given to the patients with bladder cancer.Results Surgical operations were successfully performed for all the patients,and the recurrent rate was 62.5% （5/8）.The mean period of follow-up was 32 months （range 8-72months）.The renal function was reversed to normal in 6 out of 8 patients,and they were hitherto followed-up.One patient was treated with dialysis again after removal of transplanted graft since acute rejection.One case was treated with dialysis again after chronic allograft rejection,and the patient finally died of cerebral embolism.Conclusions Among the patients receiving allogeneic renal transplantation due to AAN,the risk of developing UC is high.The carcinoma presents a multiple feature and with a high rec

关 键 词：马兜铃酸 肾移植 尿路上皮癌 

分 类 号：R737.15[医药卫生—肿瘤]