肾移植后恶性肿瘤58例的治疗体会

目的 总结肾移植后并发恶性肿瘤的治疗体会.方法 同顾分析1812例肾移植后接受免疫抑制治疗6个月以上患者的资料.1812例中,58例发牛恶性肿瘤.患者发生恶性肿瘤时的年龄为31～67岁,平均为45岁,诊断时间为移植术后18～220个月,平均为98个月.58例中,44例经病理检查证实为恶性肿瘤,其中泌尿系统肿瘤19例,消化系统肿瘤14例,血液系统肿瘤5例,其他6例;6例临床诊断为恶性肿瘤,但未经病理证实;8例资料不全,不参与结果 统计.50例参与统计的患者接受以外科手术为主的综合治疗,其中10例停用免疫抑制剂,其余40例的免疫抑制剂用量减少1/3～1/2.结果 50例诊断肿瘤后的1年存活率为68.0%,其中19例泌尿系统肿瘤患者的1年存活率为73.7%,14例消化系统肿瘤患者的1年存活率为42.9%.同前存活的26例中,移植肾仍有功能者20例,维持性血液透析者2例,腹膜透析者4例.结论 完善的随访制度有利于肾移植后恶性肿瘤的早期诊断,此类患者的治疗以手术治疗为主,同时应合理减少免疫抑制剂的用量,并调整用药方案.

Clinical experience in treatment of malignant tumors after kidney transplantation

Objective To summarize the clinical experience in treatment of malignant tumors of renal allograft recipients. Methods A retrospective study was performed on renal allograft recipients who received immunosuppressive treatment at least half a year between 1978 and 2005. Results Fifty-eight cases of tumors were found in 1812 cases undergoing renal transplantation, 50 cases of them who had complete clinical data were included into analysis. Forty-four cases, that included 19 cases in rological system, 14 cases in digestive system, 5 cases in blood system, 6 cases in other systems, were diagnosed as having malignant tumors by pathological analysis. Most of them were treated with surgery. One-year survival rate was 68.0% after the diagnosis of malignant tumor. The longest survival time was 6.5 years. Most of the survivals possessed normal function of allograft. Conclusion Systemic follow-up is important for renal allograft recipients who suffered malignant tumors. Surgical operation is still the main therapy for those solid tumors. It is critical for the therapy of malignancies and quality of life to possess satisfactory allograft function. The strategy of treatment should take consideration of the relationship between the decrease dose of immunosuppressive agents and the preservation of allograft function.