肾移植术后并发泌尿系统恶性肿瘤44例临床分析

Clinical study of 44 cases of urological malignant tumors following kidney transplantation

目的对肾移植受者并发泌尿系统恶性肿瘤的情况进行分析,探讨其防治措施。方法回顾分析肾移植术后发生泌尿系统恶性肿瘤的44例患者的临床资料。44例受者的免疫抑制方案,11例为环孢素A(CsA)、霉酚酸酯及泼尼松(Pred)联用,1例采用CsA、咪唑立宾及Pred联用,1例采用他克莫司、咪唑立宾及Pred联用,其余采用CsA、硫唑嘌呤及Pred联用。结果44例的肿瘤诊断时间为移植后2～273个月,中位数为39.5个月,其中。肾细胞癌5例,双侧肾盂输尿管癌10例,单侧肾盂输尿管癌16例,输尿管癌1例,膀胱癌12例;共有8例出现淋巴结或远处转移。诊断肿瘤后,对免疫抑制方案进行调整,43例患者接受了手术治疗,1例由于诊断不及时,丧失手术机会。经过治疗,39例存活,5例死亡。结论肾移植术后恶性肿瘤尤其是泌尿系统恶性肿瘤的发生率明显升高,治疗的关键在于早期诊断、及时手术,并辅以免疫抑制方案的调整。

Objective To analyze the occurrence of urological malignant tumors following kidney transplantation and investigate the measures of prevention and treatment. Methods A retrospective analysis on 44 cases of urological malignant tumors following kidney transplantation was performed. Of the 44 patients, 11 received CsA ＋ MMF ＋ Pred, 1 CsA ＋ mizoribine ＋ Pred, 1 FKS06 ＋ mizoribine ＋ Pred, and the remaining 31 CsA ＋ MMF ＋ Pred. Results The mean time diagnosed of malignant tumors ranged from 2 to 273 months with a median of 39. 5 months. Among the 44 patients, there were 5 cases of renal cell carcinoma, 10 cases of bilateral pelvic transitional cell carcinoma （TCC）, 16 cases of unilateral pelvic TCC, 1 case of ureter TCC and 12 cases of bladder TCC. Surgical treatment was carried out on 43 cases. One case was diagnosed out of promptly and had no chance to get operation. Five cases died. Conclusion The incidence of malignant tumors especially urological malignant tumors after kidney transplantation is significantly increased. More attention should be paid to early diagnosis, timely surgical treatment and reduction of immunosuppressive agents.