肾移植术后并发泌尿系统肿瘤8例报告

Diagnosis and treatment of urologic neoplasms of kidney recipients following renal transplantation

目的总结肾移植术后并发泌尿系统肿瘤的诊治体会。方法8例患者在肾移植术后3-16年出现间歇性血尿,通过B超、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1例为肾盂肿瘤,3例为输尿管肿瘤,3例为膀胱肿瘤,1例为尿道肿瘤。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;3例膀胱肿瘤患者中,2例行经尿道膀胱肿瘤电切术,1例膀胱全切术,在行肿瘤切除术前后需适当调整免疫抑制治疗方案。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1例患者因肿瘤复发或新发而接受了二次肿瘤切除术,1例发生肺转移;8例患者10次手术均顺利,治疗效果满意。结论对肾移植术后并发泌尿系统肿瘤的患者,关键在于早期诊断、积极治疗,应慎重对待肾移植术后出现血尿的患者,以免漏诊。

Objective To summarize the experience of diagnosis and treatment of urologic neoplasms of kidney recipients following renal transplantation. Methods From April 1990 to Aug. 2006, about over 1 500 kidney transplantations were performed and 8 patients were diagnosed as renal tumors by B-ultrasound, IVU, cystoscopy, and CT etc, including 1 case of renal pelvis tumor, 3 cases of ureter tumor and 3 cases of cyst tumor, and 1 case of penis tumor. 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.