肾移植术后并发双侧自体肾盂和输尿管移行细胞癌16例  

Clinical analysis of bilateral native pelvic and ureteral transitional cell carcinoma following renal transplantation

作　　者：王玮[1] 尹航[1] 李晓北[1] 杨晓勇[1] 任亮[1] 刘航[1] 张鹏[1] 胡小鹏[1] 王勇[1] 张小东[1] 

机构地区：[1]首都医科大学附属北京朝阳医院,100020

出　　处：《中华器官移植杂志》2011年第8期474-476,共3页Chinese Journal of Organ Transplantation

摘　　要：目的总结肾移植术后发生双侧自体肾盂、输尿管移行细胞癌的诊治经验。方法回顾性分析16例肾移植术后发生双侧自体肾盂、输尿管移行细胞癌患者的资料。首次发现上尿路肿瘤的时间为移植后（56．2±33．0）个月。2例同时发现双侧上尿路肿瘤，其余14例双侧上尿路肿瘤先后发现的时间间隔为（8．6±6．7）个月。临床症状和检查阳性结果以血尿和自体肾积水为主。均行自体上尿路根治性切除术，术后行膀胱灌注化疗。结果16例手术均成功。32次自体肾、输尿管的病理检查结果均为移行细胞癌，包括单纯肾盂肿瘤4次，单纯输尿管肿瘤9次，合并肾盂、输尿管肿瘤19次。23次肾盂肿瘤的分级为1级8例，2级11例，3级4例；28次输尿管肿瘤的分级为1级6例，2级10例，3级12例。术后随访（26．8±25．1）个月，1例出现肺部转移后死亡；1例发生腰背部软组织转移性移行细胞癌，局部切除；其他患者未发现肿瘤复发及转移。结论肾移植后自体上尿路移行细胞癌的常见表现为血尿合并自体肾积水，该肿瘤侵袭性较强，对于膀胱及一侧自体上尿路同时存在移行细胞癌者，应行对侧自体肾上尿路预防性切除术。Objective To investigate the clinical features of bilateral native pelvic and ureteral transitional cell carcinoma （TCC） in renal transplant patients. Methods A retrospective analysis was carried out on 16 patients with bilateral native pelvic and ureteral TCC after kidney transplantation. The mean time between transplantation and diagnosis of upper urinary TCC was 56. 2 ± 33.0 months. Two patients were suffered from bilateral upper urinary TCC at the same time. The mean interval between 2 upper urinary tract operations of the remaining 14 cases was 8. 6 ± 6. 7 months. Hematuria and hydronephrosis of native kidneys were the main symptoms and targets in checkup. Intravesical chemotherapy was postoperatively given. Results All operations were performed successfully. All specimens obtained from the operations were pathologically diagnosed as TCC. The TCC location involved pure native pelvis （n = 4）, pure native ureter （n = 9）, and pelvis combined with ureter （n = 19）. Pelvic TCC pathological grades included grade 1 in 8 cases, grade 2 in I1 cases, and grade 3 in 4 cases; Ureteral TCC grades included grade 1 in 6 cases, grade 2 in 10 cases, and grade 3 in 12 cases. Patients were followed up for 26. 8 ± 25.1 months. One patient died of lung metastasis. One case of lumbar soft tissue transfer was given local excision. The remaining patients had no recurrence and metastasis. Conclusion Renal transplant patients with hematuria and native renal hydronephrosis should be highly vigilant of the occurrence of upper urinary tract TCC. TCC after renal transplantation is invasive. Prophylactic contralateral nephroureterectomy should be performed on the recipients having TCC at the bladder and one side of native upper urinary tract.

关 键 词：肾移植 肾盂 输尿管 癌 移行细胞 

分 类 号：R699.2[医药卫生—泌尿科学] R737.11[医药卫生—外科学]