肾移植术后并发泌尿系统肿瘤的相关因素与临床干预

目的:探讨肾移植术后并发泌尿系统肿瘤的相关因素与临床干预措施.方法:报告9例(10次)此种患者的临床资料.9例肾移植术后均行免疫抑制治疗.肿瘤均发生在自体肾、输尿管和膀胱:肾透明细胞癌、肾肉瘤和膀胱腺癌各1例,肾盂输尿管膀胱移行细胞癌6例,其中1例先发生膀胱腺癌后又发生肾盂输尿管移行细胞癌.肿瘤发生于移植术后8～146个月,且8例发生在应用新型免疫抑制剂之后.患者均有服用龙胆泻肝丸或冠心苏合丸史.8例接受了根治性手术,1例未能手术切除.结果:9例随访8～44个月,未能手术切除1例于术后5个月肝转移死亡.1例肉瘤复发后放弃治疗后死亡.1例膀胱肿瘤复发,行膀胱全切腹壁造瘘术,1例腺癌已出现肺和胸膜转移.另5例最后随访时存活良好.结论:肾移植术后并发泌尿系统肿瘤以移行细胞癌为多;可能与服用含马兜铃的中药和应用新型免疫抑制剂有关;根治性手术治疗、减少免疫抑制剂用量和更换免疫抑制剂种类是主要临床干预措施.

Analysis of malignancies in the urinary system after renal transplantation(Report of 10 times in 9 cases)

Objective:To study the incidence and clinical feature of malignancies in the urinary system in renal transplantation recipients. Methods:A retrospective study of 10 malignancies in the urinary system after renal transplantation in 9 cases was carried out. Results:All tumors occured in their own kidney,ureter or bladder. There were 1 clear-cell carcinoma of renal, 1 nephrosarcoma,2 transitional cell carcinoma of renal pelvis,3 transitional cell carcinoma of bladder, 2 transitional cell carcinoma in both renal pelvis and ureter,1 no pathology report. Nine cases of malignancies in the urinary system occurred during 8 to 126 months after renal transplantation. They all underwent the application of the traditional Chinese medicine contain of aristolochic acid. The urologic malignant tumor of post-transplantation was found after applying new immunosuppressive agent. Renal function was normal in 6 patients, abnormal in 3. The treatment included surgery and chemical therapy, with decreased dose of immunosuppressive agents. Eight cases underwent radical surgery. Conclusions:Malignancies in the urinary system after renal transplantation should be alert. The risk factors may includ using the traditional Chinese medicine contain of aristolochic acid and applying new immunosuppressive agent.