长期服用含马兜铃酸中药伴发尿路移行细胞癌15例临床分析

Analysis of 15 cases of transitional cell carcinoma with aristolochic acid-containing in Chinese herbs as a causative factor

目的：探讨长期服用马兜铃酸伴发尿路移行细胞癌患者的临床特点。方法：分析15例有长期服用含有马兜铃酸中药史并在我院确诊为尿路移行细胞癌患者的临床资料,其服药时间为1.0~25.0年,平均6.1年。结果：11例患者首发症状为间歇性无痛肉眼血尿,2例镜下血尿,1例腰痛,1例体检时超声检查偶然发现输尿管肿瘤。经尿脱落细胞检查、B超、泌尿系三维CT、磁共振尿路造影、静脉肾盂造影、逆行肾盂输尿管造影、膀胱镜、输尿管镜等明确诊断。15例患者均在我院手术治疗：采用经尿道膀胱肿瘤电切术或根治性膀胱全切术,腹腔镜行肾/输尿管全长加膀胱内输尿管口电切术,姑息性单纯肿瘤切除术。15例患者术后病理诊断均为尿路移行细胞癌,其中11例为多发或多中心肿瘤。全部随访6~36个月,平均13个月。2例分别于术后23、33个月死于多发转移。结论：长期服用含马兜铃酸中药的患者出现血尿时应高度怀疑尿路发生移行细胞癌的可能性,马兜铃酸与尿路多发或多中心肿瘤是否相关尚需进一步研究。

Objective：To discuss the clinical character of patients with transitional cell carcinoma and had a history of taking aristolochic acid（AA）-containing in Chinese herbs.Methods：Fifteen patients were diagnosed as transitional cell carcinoma in our hospital who also had a history of taking AA-containing Chinese herbs,and medication for 1-25 years.The clinical data were collected and analyzed statistically.Results：Of them,11 patients had intermittent gross hematuria as primary symptom,2 had relapsing microscopic hematuria,1 had flank pain and 1 was found through health examination.All patients were diagnosed by ultrasound,urine cytological examination,CT scan,magnetic resonance urography,intravenous pyelogram,retrograde pyelogram,cystoscope,and ureteroscopes.All patients received surgery at our hospital.Surgical procedures were including radical cystectomy,trans-urethral resection of the bladder tumor,radical nephrectomy,palliative tumorectomy.Pathology findings showed transitional cell carcinoma.Eleven patients had multi-centered tumor cells.All patients have been followed up for 6-36 months with mean 13 months,2 of them were died.Conclusion：Patients should be highly suspected for transitional cell carcinoma,who have hematuria with a history of taking AA-containing Chinese herbs.The relationship between AA and multi-centered tumors is still a debate and needs further research to prove it.