卡介苗灌注治疗肾移植继发膀胱癌患者的初步经验  

Preliminary experience of Bacillus Calmette-Guerin in the treatment of bladder cancer secondary to kidney transplantation

作　　者：曾胜 白志杰[1] 刘光明[1] 王海峰[1] 李闯 刘佳毅 马洪顺[1] 刘谦[1] Zeng Sheng;Bai Zhijie;Liu Guangming;Wang Haifeng;Li Chuang;Liu Jiayi;Ma Hongshun;Liu Qian(Department of Urology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院泌尿外科,300192

出　　处：《中华泌尿外科杂志》2021年第3期176-179,共4页Chinese Journal of Urology

基　　金：国家自然科学基金(51673150);天津市卫生计生委基金重点公关项目(16KG103)。

摘　　要：目的总结卡介苗膀胱灌注治疗肾移植继发膀胱癌患者的经验。方法回顾性分析2015年1月至2019年12月天津市第一中心医院5例肾移植后继发膀胱癌行卡介苗膀胱灌注患者的临床资料。男1例,女4例;移植后应用免疫抑制剂期间1例(例1)继发高级别非肌层浸润性膀胱癌(NMIBC),3例(例2、3、5)继发低级别NMIBC,1例(例4)继发腺性膀胱炎后发展为低级别NMIBC;5例继发膀胱癌的年龄为(59.7±4.0)岁。例1行经尿道膀胱肿瘤切除术(TURBT)后膀胱灌注表柔比星,例3、例5 TURBT术后规律膀胱灌注吉西他滨,例2 TURBT术后未灌注药物;此4例于术后(20.1±9.7)个月膀胱癌均复发,均再次行TURBT,病理提示其中3例(例1、2、5)为高级别NMIBC,1例(例3)为低级别NMIBC;4例第2次TURBT术后2周予膀胱灌注卡介苗。例4 TURBT术后病理提示低级别NMIBC,术后2周灌注卡介苗。5例卡介苗灌注治疗期间,继续应用免疫抑制剂。从患者灌注卡介苗后开始随访。结果卡介苗灌注治疗期间,5例中4例出现卡介苗相关局部炎症反应,其中2例表现为膀胱刺激症状,1例表现为血尿,1例表现为血尿合并低热。伴膀胱刺激症状及血尿患者经大量饮水、卧床休息、服用左氧氟沙星(0.5 g/d×7 d)治疗后症状好转,低热患者予以退热处理;卡介苗灌注治疗期间未预防性应用抗结核药物。5例未出现结核感染的相关表现和败血症,移植肾功能正常,未出现排斥反应。5例随访时间7~24个月,其中1例在卡介苗膀胱灌注第7个月后失访,随访过程中5例均未见肿瘤复发和转移。结论免疫抑制剂的使用未降低灌注卡介苗的生物学活性,同时卡介苗灌注未增加免疫功能低下患者的全身毒性反应,未影响移植肾功能;膀胱灌注卡介苗是肾移植继发膀胱癌的一种治疗选择。Objective To summarize the experience of Bacillus Calmette-Guerin(BCG)in the treatment of bladder cancer secondary to renal transplantation.Methods The clinical data of 5 patients who underwent BCG bladder irrigation after secondary bladder cancer after kidney transplantation in Tianjin First Central Hospital from January 2015 to December 2019 were analyzed.There were 1 male and 4 female cases.During the period of immunosuppression after transplantation,1 case developed secondary high-level non-muscular invasive bladder cancer(NMIBC),3 cases developed secondary low-grade NMIBC,and 1 case developed secondary glandular cystitis(4 cases).The mean age of the 5 patients with secondary bladder cancer was 59.7±4.0 years.Case one with high level NMIBC was treated with transurethral resection of bladder tumor(TURBT)and postoperative irrigation of epirubicin.Case 3 and 5 with low-level NMIBC accepted regular postoperative irrigation of gemcitabine.No irrigative therapy was performed in case 2.Bladder cancer recurred in case 1,2,3 and 5 after 20.1±9.7 months.TURBT was observed in all the 4 patients,among which 3 were of high grade NMIBC and 1 was of low grade NMIBC.Four patients were irrigated with BCG 2 weeks after operation.Postoperative pathology indicated low-level NMIBC in case 4,and BCG was irrigated 2 weeks after the operation.During perfusion therapy,immunosuppressive agents were continued.Results During BCG perfusion,4 of the 5 cases showed BCG related local inflammation,among which 2 cases presented symptoms of bladder irritation,1 case presented hematuria,and 1 case presented hematuria with low fever.Patients with frequent urination,pain in urine,hematuria and other symptoms improved after drinking plenty of water,taking bed rest and taking levofloxacin(0.5g/day×7 days).Patients with low fever were treated with antipyretic treatment.No antituberculous agents were used prophylactically during BCG perfusion.There were no symptoms of tuberculosis infection or sepsis.The function of transplantated kidney was norma

关 键 词：膀胱肿瘤 肾移植 卡介苗 免疫抑制 复发 

分 类 号：R737.14[医药卫生—肿瘤]