肾移植术后原尿路上皮癌的手术治疗及预后进展

Progress of surgical treatment for native upper urinary tract urothelial carcinoma in kidney transplant recipients and their prognosis

肾移植术后患者由于长期服用免疫抑制剂或既往服用马兜铃酸药物,罹患上尿路尿路上皮癌(upper urinary tract urothelial carcinoma,UUT-UC)的风险增加,根治性肾输尿管全长切除及膀胱袖状切除术是治疗UUT-UC的金标准,既往采用开放式手术,后来腹腔镜技术逐渐取代开放术式,但腹腔镜手术入路、远端输尿管处理、标本取出等步骤的具体方式以及相应肿瘤学结果仍有所不同;肾移植受者因曾行肾移植手术,局部瘢痕组织粘连重,腹腔镜下操作空间较小,可能影响下段输尿管及周围膀胱壁袖状切除;此外,肾移植术后受者发生原上尿路肿瘤可成为肾移植受者长期存活的致命危险因素。因此,探讨不同步骤的手术方式及其预后有助于优化手术方案,使患者获益。本文对近年来UUT-UC的手术治疗进展及预后作一综述。

Kidney transplant recipients have an increasing risk of upper urinary tract urothelial carcinoma（UUT-UC）due to long-term use of immunosuppression medications and previous use of aristolochic acid.Radical nephroureterectomy and bladder cuff excision has been the gold standard treatment for UUT-UC.Previously,open nephroureterectomy and bladder cuff excision was adopted.With the development of laparascopic technique,laparascopic approach gradually replaced the open one.Oncologic outcomes vary with different laparascopic approaches,distal ureter managements and specimen retrieval.In kidney allograft recipients,scar tissue that binds together as well as confined space under laparoscope could compound the difficulty in dissecting lower ureter and bladder cuff excision.Furthermore,native UUT-UC could become a lethal risk factor of patients＇ long-term survival.Therefore,to explore different laparascopic approaches and its oncology outcomes is conducive to optimizing surgery procedures and benefiting patients.The article is written to review the literature about surgery treatment for native UUT-UC and its prognosis in renal transplant recipients.