论文部分内容阅读
目的分析肾移植患者并发尿路上皮肿瘤的特点,探讨其诊治方法。方法自1998-2003年肾移植患者1293例,术后发生尿路上皮恶性肿瘤21例(1.6%)。男4例,女17例。17例原发病为慢性间质性肾炎。发生尿路上皮肿瘤距肾移植6～62个月,平均26个月。其中膀胱癌6例,单侧肾盂或输尿管癌6例,单侧肾盂或输尿管、膀胱癌8例。双侧。肾盂输尿管癌1例。10例上尿路肿瘤发生部位与移植肾同侧,4例发生于移植肾对侧。临床症状以无痛性肉眼血尿和反复泌尿系感染为主。19例行手术治疗,术后所有患者免疫抑制剂用量减少1/3并辅以局部灌注化疗。结果2例行姑息性治疗的晚期肿瘤患者分别于发现肿瘤5、8个月死亡。余19例现已随访2～5年。13例肿瘤复发,复发部位为膀胱或对侧原肾、输尿管。所有患者在免疫抑制剂减量期间均未出现急性排斥。2例因切除移植肾恢复透析,17例肾功能正常。结论慢性间质性肾炎导致肾功能衰竭的肾移植患者和女性肾移植患者易发生移植后尿路上皮肿瘤；移植肾同侧上尿路较对侧好发肿瘤；对移植肾对侧为首发的上尿路发生肿瘤者可预防性行双侧上尿路根治性切除。
OBJECTIVE: To analyze the characteristics of urothelial cancer in patients with renal allograft and to explore its diagnosis and treatment. Methods A total of 1293 renal transplant recipients from 1998 to 2003 were retrospectively analyzed. Twenty-one patients (1.6%) had urothelial carcinomas. 4 males and 17 females. 17 cases of primary disease of chronic interstitial nephritis. Occurrence of urothelial tumors from kidney transplantation 6 to 62 months, an average of 26 months. Including 6 cases of bladder cancer, unilateral renal pelvis or ureter in 6 cases, unilateral renal pelvis or ureter, bladder cancer in 8 cases. Bilateral. One case of ureteropelvic cancer. Ten cases of upper urinary tract tumor site ipsilateral to the kidney graft, 4 cases occurred in the contralateral kidney graft. Clinical symptoms with painless gross hematuria and recurrent urinary tract infections. Nineteen patients underwent surgical treatment. The dosage of immunosuppressive drugs in all patients decreased by 1/3 and supplemented with local infusion chemotherapy. Results Two patients with advanced gastric cancer treated with palliative treatment died at 5 and 8 months respectively. The remaining 19 cases have been followed up for 2 to 5 years. 13 cases of tumor recurrence, the site of recurrence of the bladder or the contralateral kidney, ureter. All patients showed no acute rejection during the immunosuppressive dose reduction. In 2 cases, dialysis was resumed due to the removal of allograft and 17 cases had normal renal function. CONCLUSIONS: Renal transplantation patients with renal failure caused by chronic interstitial nephritis and female kidney transplant recipients are prone to develop transplanted urothelial tumors. The ipsilateral upper urinary tract of the transplanted kidney is more prone to develop tumors than the contralateral side. Tumors in the upper urinary tract can prevent bilateral upper urinary tract resection.