肾移植术后并发泌尿系移行细胞癌8例

随着肾移植术后长期存活患者的增加,并发泌尿系肿瘤的发生率有逐渐增加的趋势[1].我们于2000年12月至2005年8月共收治同种异体肾移植术后8例发生泌尿系移行细胞癌患者,现总结报告如下.     

肾移植后泌尿系肿瘤24例的诊治体会

肾移植受者的恶性肿瘤发生率远高于正常人,其中泌尿系肿瘤的发生率最高.1998年10月至2011年12月,我院共完成肾移植2572例,其中24例(0.93％,24/2572)术后并发泌尿系肿瘤,现报告如下. 资料与方法 一、一般资料 24例中,男性10例,女性14例.肾移植时年龄为(49.3±11.6)岁(24～68岁),术后首次诊断为肿瘤时年龄为(55.6±9.8)岁(32～70岁),肿瘤诊断距手术时间为2～180个月,中位数为54个月.尸体供肾22例,亲属活体供肾2例.术后免疫抑制方案为环孢素A(CsA)+吗替麦考酚酯(MMF)+泼尼松(Pred)者16例,他克莫司(Tac)+ MMF+Pred者4例,CsA+硫唑嘌呤(Aza)+Pred者4例.     

膀胱全切回肠膀胱术后肠膀胱类癌一例报告

患者,女,55岁.50年前因膀胱肿瘤行膀胱全切回肠膀胱术,肿瘤病理不详.术后间断出现血尿、哝尿、腹痛、不全性肠梗阻、腰痛、发热等症状,均经保守治疗缓解.症状加重3个月于2008年11月28日入院.     

成人先天性巨输尿管症37例诊疗分析

目的：探讨成人先天性巨输尿管症（CM）的诊治方法.方法：回顾性分析37例成人CM的临床资料：男18例,女19例.左侧18例,右侧10例,双侧9例.超声检查、静脉尿路造影（IVU）检查提示输尿管全段扩张伴肾盂积水22例,输尿管下段扩张9例.IVU不显影或显影不清13例;同位素肾动态显像检查提示患肾不同程度损害.手术治疗34例,其中行肾输尿管切除术2例,输尿管膀胱再植术32例.间断性双J管置入1例,保守观察2例.结果：随访32例,随访时间4个月～20年.患侧肾输尿管积水减轻29例,无明显变化3例.结论：成人CM的诊断主要依据影像学检查.治疗原则为解除梗阻、尽量保留息肾功能,应根据输尿管扩张程度选择输尿管折叠或裁剪加输尿管膀胱再植术,吻合方法推荐Lich-Gregoir术式;肾功能良好、无明显症状者可保守治疗.     

膀胱移行细胞癌阴茎转移一例报告

膀胱移行细胞癌阴茎转移罕见,我院2009年12月收治1例,现报告如下.患者,75岁.主因"全膀胱切除术后21个月,阴茎肿痛1个月"于2009年12月25日入院.患者于2004年12月在外院因膀胱肿瘤行TURBt,术后病理示膀胱移行细胞癌Ⅲ级,行羟基喜树碱膀胱灌注化疗.2006年4月因膀胱肿瘤复发再次行TURBt,术中发现膀胱前壁、膀胱左侧壁和前壁交界处、左输尿管口后方大片苔藓样肿瘤,术后病理为膀胱移行细胞癌Ⅲ级,术后行吡柔比星膀胱灌注化疗8个月.2008年3月因"无痛性肉眼血尿4个月"入院,膀胱镜检示膀胱左侧壁地毯样隆起,范围3 cm×3 cm.活检病理示膀胱移行细胞癌Ⅲ级,灶性呈腺癌分化.遂行根治性膀胱全切术+回肠膀胱术.术后病理示膀胱移行细胞癌Ⅲ级,灶性呈腺癌分化,侵及膀胱壁全层.双侧输尿管切端,尿道切端,左右精囊未见癌侵及,左右髂血管旁淋巴结未见转移癌.     

经腹及阴茎根部切口全膀胱尿道切除术10例报告

2001—2004年我们采用经腹及刚茎根部切口全膀胱尿道切除术治疗膀胱移行细胞癌患者10例，效果较好，现报告如下。     

肾移植术后并发自体尿路上皮多器官癌六例的临床分析

Objective To analyze the etiology, clinical diagnosis and outcomes of 6 cases of multifocal urothelial carcinomas following transplantation. Methods A retrospective analysis was performed on 6 cases of multifocal urothelial carcinomas following renal transplantation in our center. Results Six patients were diagnosed as having multifocal urothelial carcinomas, including 1 case of related renal transplantation. Five cases were diagnosed by painless gross hematuria 2～48 months after renal transplantation, and I patient was diagnosed as having bladder tumors by B-uhrasound. All lesions happened un-simultaneously, from 1.5～16 months, and each case accepted operation 2～5 times. One case accepted radical cystectomy and cutaneous ureterostomy of the graft, and one accepted radical cystectomy, cutaneous ureterostomy of the graft and urethrectomy. All of 6 cases received OKT3 or Daclizumab as the induced-immunosuppressive therapy and tacrolimus or cyclosporine A + mycofenolate mofetil + steroid as the maintenance therapy. Intravesical chemotherapy started in all patients immediately after the surgery. All operations were successful and most patients got satisfactory results. Conclusions Kidney recipients have a higher rate of transitional cell carcinomas which are characterized by easy metastasis, and mostly have unsatisfactory prognosis. Kidney recipients with hematuria should be examined carefully with cystoscopy, retrograde pyelography and cystourethroscopy. A routine examination at regular intervals after transplantation is very important.     

肾移植术后并发自体尿路上皮多器官癌六例的临床分析

Objective To analyze the etiology, clinical diagnosis and outcomes of 6 cases of multifocal urothelial carcinomas following transplantation. Methods A retrospective analysis was performed on 6 cases of multifocal urothelial carcinomas following renal transplantation in our center. Results Six patients were diagnosed as having multifocal urothelial carcinomas, including 1 case of related renal transplantation. Five cases were diagnosed by painless gross hematuria 2～48 months after renal transplantation, and I patient was diagnosed as having bladder tumors by B-uhrasound. All lesions happened un-simultaneously, from 1.5～16 months, and each case accepted operation 2～5 times. One case accepted radical cystectomy and cutaneous ureterostomy of the graft, and one accepted radical cystectomy, cutaneous ureterostomy of the graft and urethrectomy. All of 6 cases received OKT3 or Daclizumab as the induced-immunosuppressive therapy and tacrolimus or cyclosporine A + mycofenolate mofetil + steroid as the maintenance therapy. Intravesical chemotherapy started in all patients immediately after the surgery. All operations were successful and most patients got satisfactory results. Conclusions Kidney recipients have a higher rate of transitional cell carcinomas which are characterized by easy metastasis, and mostly have unsatisfactory prognosis. Kidney recipients with hematuria should be examined carefully with cystoscopy, retrograde pyelography and cystourethroscopy. A routine examination at regular intervals after transplantation is very important.     

B超引导下经皮肾镜碎石术治疗肾下盏结石效果观察

目的探讨B超引导下经皮肾镜碎石术(PCNL)治疗肾下盏结石的临床疗效。方法肾下盏结石患者45例,结石直径8～35 mm,按结石径线分为≤20 mm组(A组)18例,>20 cm组(B组)27例,均在B超引导下行PCNL。结果 45例手术均成功,其中一期碎石41例,二期碎石4例;术后泌尿系X线平片(KUB)发现4例结石残留,总无石率为91.1%,A组手术时间为(64.4±20.2)min,无石率为94.4%(17/18),B组分别为(90.7±22.9)min、88.9%(24/27),两组手术时间相比,P<0.05,两组无石率相比,P>0.05。术后发生持续血尿需输血者2例,高热3例,经相应处理后均恢复。A、B组并发症发生例数(分别为2、3例)无明显差异(P>0.05)。两组均无肾周血肿、尿外渗、血气胸、结肠穿孔、肝脾等重要脏器损伤及死亡病例。结论 B超引导下经皮肾镜碎石术治疗肾下盏结石具有成功率高、安全、创伤小等特点,疗效不受结石大小影响。     

肾移植术后并发自体尿路上皮多器官癌六例的临床分析

目的 探讨6例肾移植术后并发自体尿路上皮多器官癌的病因、临床诊断及治疗结果.方法 回顾性分析6例肾移植术后并发自体尿路上皮多器官癌患者的临床资料,对肿瘤的发生原因、临床诊断和治疗结果进行了总结.结果 6例患者肾移植术后均采用环孢素A(CsA)或他克莫司(Tac)+霉酚酸酯(MMF)+泼尼松(Pred)的三联免疫抑制方案;并以抗CD3单克隆抗体(OKT3)或达利珠单抗进行免疫诱导.6例患者发生肿瘤的时间在肾移植术后2～48个月,平均为26个月.除1例是在使用B型超声波复查时发现膀胱肿瘤外,其余患者均以间歇性血尿为首发症状,临床症状发生后通过B型超声波、尿找脱落瘤细胞、膀胱镜、输尿管镜、静脉尿路造影(IVU)、逆行肾盂造影及CT明确诊断,并经内窥镜下取材活检证实.6例患者均为非同时发生的尿路上皮多器官癌,非同时发生肿瘤的间隔期为1.5～15个月.每例患者均因肿瘤复发或新发而接受了2～5次肿瘤切除术,其中1例行全膀胱切除术及移植肾输尿管皮肤造瘘术,1例行全膀胱切除术、移植肾输尿管皮肤造瘘术及全尿道切除术.术后均通过膀胱灌注给予丝裂霉素、吡柔比星和表柔比星等进行化疗.治疗效果满意,但复发率高.结论 肾移植术后并发的尿路上皮多器官癌与免疫抑制剂的使用密切相关;并发自体尿路上皮多器官癌往往进展快,易扩散和转移,因此,应注重患者移植后的筛查,做到早期诊断,积极治疗,慎重对待移植肾切除.