国内肾移植后并发尿路恶性肿瘤85例分析

An assemble analysis of malignancies in urinary tract after renal transplantation in china(Report of 85 cases)

目的:探讨国内肾移植术后并发尿路恶性肿瘤的发病现状和临床特征,提高对肾移植后尿路恶性肿瘤的的认识及诊治水平。方法:通过中国生物医学数据库及清华同方全文数据库等文献检索系统,统计1978年至今国内公开报道的肾移植术后并发尿路恶性肿瘤共85例,对上述患者的临床资料进行回顾性分析。结果:肾移植术后至诊断肿瘤有时间报告的73例中>12个月65例(占89.1%)。肿瘤发生部位以膀胱最多,占肾移植术后尿路恶性肿瘤的59.0%。肿瘤病理类型以移行细胞癌最多,与一般泌尿系统肿瘤相比恶性程度高、分化差的病理类型所占的比例高为10.9%。临床表现以血尿最多见占81.8%。治疗以根治性手术为主的综合治疗,并调整免疫抑制剂用量一般减少1/2～1/4。肿瘤的地域分布北方发生率(占65.9%)明显高于南方。结论:肾移植术后并发尿路恶性肿瘤是肾移植术后一种严重的并发症,应予以重视,争取早期诊断,治疗应以根治性手术为主综合治疗,同时减少免疫抑制剂用量。

Objectives： To summarize the present situation and clinical characteristics of malignancies in urinary tract after renal transplantation in china. Methods： All the data were selected from the Chinese Bio - Medical Data - base and the Chinese Journal Full - text Data - base. 25 articles were reviewed, in which the 85 cases of malignancies in urinary tract after renal trans- plantation were retrospectively analyzed. Results： There were 85 cases of malignancies in urinary tract after renal transplantation reported by civil documents from January 1978 to September 2005. The most site of tumorigenesis was bladder （59.0%）. The bad - differentiated pathological type and high malignancy was found in malignancies of urinary tract after renal transplantion. 82 eases were transitional cell carcinonma of urinary tract. The common clinical symptom of the diease was hematurin. 27 of 33 patients had hematurin（81.8% ）. The treatment included surgical treatment and chemical therapy. Then decreased the immunosuppressive agents. There was higher incidence of malignant tumor in urinary tract of post - transplantation in the northernof cbina （65.9%） than in the southern＇ s. Conclusions： Malignancies in urinary tract after renal transplantation should be payed more attention by clinicians. Early diagnosis was very important. The treatment included the declease of immunosuppressive agents and the complete removal of the tumor lesion.