肾移植术后并发自体泌尿系统移行细胞癌九例的诊治体会

Diagnosis and treatment of transitional cell carcinoma of kidney recipients following renal transplantation

目的总结肾移植后并发自体泌尿系统移行细胞癌的诊治体会。方法9例患者在肾移植术后11～48个月出现间歇性血尿,通过B型超声波、静脉尿路造影(IVU)、膀胱镜、输尿管镜、逆行肾盂造影、CT及内窥镜下取材活检等,证实3例为肾盂肿瘤,2例为输尿管肿瘤,4例为膀胱肿瘤。肾盂肿瘤和输尿管肿瘤的5例均采取肾、输尿管全程及膀胱部分切除术;4例膀胱肿瘤患者中,3例行经尿道膀胱肿瘤电切术,1例施行膀胱全切及移植肾切除术。有2例患者因肿瘤复发或新发而接受了2次肿瘤切除术。术后通过膀胱灌注给予丝裂霉素、吡柔比星、表阿霉素等进行化疗。结果9例患者11次手术均顺利,治疗效果比较满意,在施行肿瘤切除术前后不需调整免疫抑制治疗方案。结论对肾移植后并发自体泌尿系统移行细胞癌的患者,关键在于早期诊断、积极治疗,应慎重对待肾移植后出现血尿的患者,以免漏诊。

Objective To summary the experience of diagnosis and treatment of transitional cell carcinoma of kidney recipients following renal transplantation. Methods From Jan. 2001 to July 2005, 600 kidney transplantations were performed and 9 patients were diagnosed as having renal tumors by B-ultrasound, IVU, cystoscopy, CT etc. , including 3 cases of tumor of renal pelvis, 2 cases of tumor of ureter and 4 cases of tumor of cyst. Corresponding surgical operations were performed. Results All operations were successful and most patients got satisfactory results. Conclusion Kidney recipients have a higher rate of transitional cell carcinoma. Kidney recipients with hematuria should be examined carefully with cystoscopy, retrograde pyelography and cystourethroscopy.