肾移植术后并发自体尿路上皮恶性肿瘤26例的临床分析

Clinical Analysis of Autologous Urinary Epithelial Malignant Tumors Following Kidney Transplant of 26 Cases Recipients

目的:总结肾移植受者泌尿系统尿路上皮肿瘤的发病情况、临床特征及治疗方法。方法:回顾性分析山西省第二人民医院移植透析中心1 062例肾移植受者发生泌尿系统尿路上皮恶性肿瘤20人26例次的资料(发生率1.88%)。结果:泌尿系统尿路上皮恶性肿瘤26例,原发肾盂癌8例,输尿管癌8例,膀胱癌10例。随访至2015年5月,死亡5例,3例死亡原因为术后远处多发转移,放弃手术的死亡2例。生存15例,1例维持血液透析状态,14例随访移植肾功能正常,未发现肿瘤。结论:定期行泌尿系筛查可早期发现肾移植术后泌尿系统尿路上皮恶性肿瘤;宜采取外科手术与免疫抑制剂减量或转换为西罗莫司相结合的个体化治疗方案。

Objective： To analyze the incidence, epidemiographic features and treatment options of urological malignant tumor in kidney transplant recipients. Methods：The aretrospective study was performed on 26 data of 20 patients with urological malignancy in 1062 renal allograft recipients during Januray 2001 to December 2012. （ the incidence ： 1. 88）. Followed till May 2015, five cases died, three of which died of postoperative multiple transfer in the distance and two of which had given up the operation. Fifteen cases survived, including one maintaining hemodialysis and 14 maintai- ning normal renal allograft function without any tumor. Results：8 cases of pelviccarcinomas, 8 cases of native ureteral carcinomas and 10 cases of bladder cancers were included in 26 patients diagnosed as urological malignancy. Conclu- sions：Urological epithelial malignant tumor is an important complication after renal transplant. Regularly urinary screen- ing can help to find urological malignant tumor at early stage. Surgery and immunosuppression reduction or conversion from CNI to SRL should be individualized to achieve maximum benefits for patients.