肾移植术后并发自体泌尿系统恶性肿瘤22例的临床分析  被引量:1

Analysis of 22 cases of urological de novo malignant tumor in kidney transplant recipients

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作  者:郝俊文[1] 宋华[1] 林长胜[1] 李香铁[1] 刘少鸽[1] 张爱民[1] 

机构地区:[1]济南军区总医院泌尿外科,250031

出  处:《中华器官移植杂志》2011年第12期735-737,共3页Chinese Journal of Organ Transplantation

摘  要:目的分析。肾移植受者并发自体泌尿系统恶性肿瘤的临床特征。方法回顾性分析单中心1945例肾移植受者的临床资料,其中发生自体泌尿系统恶性肿瘤22例(发生率为1.13%),占所有恶性肿瘤的56.4%(22/39)。22例中肾乳头状腺癌、肾乳头状细胞癌、肾血管肉瘤各1例;肾盂移行细胞癌1例,肾盂输尿管移行细胞癌6例,输尿管移行细胞癌7例,肾盂输尿管膀胱移行细胞癌1例;膀胱恶性肿瘤4例(包括膀胱移行细胞癌3例、膀胱交界恶性肿瘤1例)。22例中,以肉眼血尿为主要症状者17例,2例反复出现镜下血尿,只有3例无明显临床症状。患者的发病年龄为(54.3±12.3)岁,诊断肿瘤的中位时间为移植术后53个月。10例采用环孢素A+硫唑嘌呤+泼尼松预防排斥反应,12例采用环孢素A+吗替麦考酚酯+泼尼松。所有患者均接受手术治疗,其中3例肾脏恶性肿瘤患者接受了根治性肾切除手术,15例肾盂、输尿管肿瘤患者接受患侧肾、输尿管切除并膀胱袖状切除,4例膀胱恶性肿瘤患者中,3例接受经尿道膀胱肿瘤电切术,1例行膀胱部分切除术。结果随访2~97个月,死亡9例,死亡时间为肿瘤手术后6~97个月,死亡原因为骨转移1例,肺转移1例,脑转移2例,肝转移2例,全身广泛转移3例。随访截止时存活13例,存活时间最长者为单纯膀胱肿瘤患者,存活92个月,存活超过4年者4例,存活超过1年者5例。结论自体泌尿系统恶性肿瘤是肾移植术后的一个重要并发症;无痛性肉眼血尿是最常见的症状;根治性手术切除是最主要的治疗手段。Objective To analyze the epidemiographic features of urological de novo malignant tumor in kidney transplant recipients in the General Hospital of Jinan Military Command. Methods The clinical data of 1945 patients who received kidney transplantation between September 1978 and December 2009 were retrospectively studied. Among 1945 recipients, 22 cases were diagnosed as having urological de novo malignant tumors ( incidence: 1.13%), including renal papillary adencaieinoma (n =1 ), papillary renal cell carcinoma (n = 1), renal hemangiosarcoma (n = 1); pelvic transitional cell carcinoma (TCC) (n = 1), pelvic and ureter TCC (n = 6), ureter TCC (n = 7), pelvic and ureter and urinal bladder TCC (n = 1), 4 cases of bladder malignant tumors (including 3 cases of bladder TCC and 1 case of borderline bladder tumor). Of the 22 cases, 17 had a main clinical manifestation of gross hematuria and 2 had microscopic hematuria, and the rest 3 had no obvious symptom. The average age at diagnosis of these 22 cases was 54. 3 ± 12. 3 years, with a mean time of 53 months after kidney transplantation. Ten cases received immunosuppressive treatment by using cyclosporine A (CsA) + azathioprine (Aza) + prednisone (Pred), while the remaining 12 received CsA + MMF + Pred. Surgical treatment was carried out in all cases: radical nephrectomy was conducted for 3 cases of renal carcinoma; total resection of kidney, ureter and sleeve-shaped resection of bladder in affected side were conducted for the 15 cases of pelvis or ureter carcinoma; for the 4 cases of bladder carcinoma, transurethral resection of bladder tumor was conducted for 3 cases while partial cystectomy was conducted for the other one case. Results During a follow-up period of 2 to 97 months, there were 9 deaths 6 to 97 months after toumorectomy. One died of bone metastasis, one pulmonary metastasis, two brain metastasis, two hepatic metastasis, and three extensive metastatic tumor soon after the diagnosis. Thirteen pat

关 键 词:肾移植 泌尿生殖系统肿瘤 

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

 

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