肾移植后并发自体同侧上尿路上皮癌11例临床分析  

Clinical analysis of 11 cases of urothelial carcinoma in the ipsilateral kidney transplant recipients

作　　者：杨占坡[1] 周文辉[1] 徐子强[1] 刘谦[1] 马洪顺[1] 

机构地区：[1]天津市第一中心医院,300192

出　　处：《中华器官移植杂志》2017年第9期555-558,共4页Chinese Journal of Organ Transplantation

摘　　要：目的探讨肾移植后并发移植肾同侧自体上尿路上皮癌的发病特点、治疗及预后。方法回顾性分析2008年1月至2016年4月间肾移植后发生自体同侧上尿路上皮癌11例患者的临床资料。患者中男性3例，女性8例，发生上尿路上皮癌距肾移植时间为12～132个月，平均为68.4个月；其中肾盂癌5例，输尿管癌4例，同时合并肾盂癌和输尿管癌2例。所有患者均发生于移植肾同侧（右侧）。11例中，以肉眼血尿为主要症状者7例，3例反复出现右侧腰疼，1例体检发现右肾积水。11例均采取手术治疗，其中完全开放性手术6例，腹腔镜联合下腹正中小切口手术5例。术后所有患者免疫抑制剂减量或转换治疗并辅以吡柔比星膀胱灌注化学治疗。结果11例手术均获得成功，术后病理检查结果均证实为尿路上皮癌。1例行姑息性治疗的晚期肿瘤患者于发现肿瘤4个月后死亡，1例患者术后36个月因肿瘤广泛转移死亡，1例患者死于呼吸衰竭，余8例患者已随访4～96个月。1例患者给予西罗莫司后出现腹泻，改为环孢素A，余8例患者随访至今移植肾功能均正常。结论腹腔镜联合下腹正中小切口治疗肾移植术后并发自体同侧上尿路上皮癌安全、有效。Objective To explore the clinical characteristic, treatment, and prognosis of urological de novo malignant tumor in kidney transplant recipients.MethodsA retrospective analysis was performed on 11 patients with urothelial carcinoma admitted in our institute between 2008 and 2016. Three patients were male and 8 patients were female. The interval between tumorigenesis and transplantation ranged from 12 to 132 months with a mean time of 68.4 months. Of the 11 cases, 5 had pelvic TCC, 4 cases had ureter TCC, and the rest 2 cases had pelvic and ureter TCC. All patients were in the same side of transplanted kidney （right）. Of the 11 cases, 7 had a main clinical manifestation of gross hematuria, 3 cases had abdomen pain of the right side, and 1 case had hydronephosis of the right side during physical examination. Surgical treatment was taken in all 11 cases, combined with chemotherapy and immunotherapy （decreased immunosuppressive agents） treatment.ResultsSurgical treatment in all 11 cases was successful, and the postoperative pathology results confirmed the diagnosis of urothelial carcinoma. One patient receiving palliative treatment died 4 months after diagnosis. One patient died of extensive metastatic disease at 36th month postoperatively, and one patient died of respiratory failure. The rest 8 cases were followed for 4-96 months. One patient was given sirolimus （SRL） but diarrhea, so cyclosporine A （CsA） was administered. The renal function in the remaining 8 patients was normal.ConclusionLaparoscopic surgery combined with middle and small incision in the treatment of autologous ipsilateral urothelial carcinoma after renal transplantation is safe and effective.

关 键 词：肾移植 泌尿生殖系统 肿瘤 

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