肾移植后膀胱肿瘤三例诊治报告

目的探讨肾移植后膀胱癌的诊断治疗方法。方法2004年11月至2006年3月，共治疗肾移植后膀胱肿瘤3例，首发症状两例为无痛性肉眼血尿，1例为难治的尿路感染。单发的表浅肿瘤1例，行经尿道肿瘤电切术（TURBt）。多发2例，1例行膀胱部分切除术，另1例行膀胱全切正位回肠膀胱术。保留膀胱的两例患者术后均定期行丝裂霉素膀胱灌注化疗。3例术后均将免疫抑制剂减量。结果行TURBt的患者术后4个月复发，再行TURBt，随访至今未见复发；行膀胱部分切除术患者至今未见复发（15个月）；行膀胱全切正位回肠膀胱术患者随访至今已9个月，未见局部及远处复发。随访期间，3例患者的肾功能均正常。结论对肾移植后血尿及迁延不愈的尿路感染，除外排异后，早期的膀胱镜检查是必要的。手术是肾移植后膀胱肿瘤的主要方法，膀胱全切正位回肠膀胱术效果良好。术后将免疫抑制剂减量可行。

Dignosis and treatment of bladder tumors after kidney transplantation(three cases)

Objective To explore the dignosis and treatment of bladder tumors after kidney transplantation.Methods 3 patients with bladder tumors after kidney transplantation were treated from November 2004 to March 2006,the first symptom were anodynia gross hematuria in 2 cases,incurable urinary tract infection in one.1 case was Solitary superficial tumor and treated by TURBt.2 cases were multiple,of them one was treated by partial cystectomy,the other radical cystectomy and orthophoria ileal conduit.After operation,regular irrigation of bladder(MMC) was applied to the 2 cases with reservation of bladder,and immune depressants in all patients decrease.Results The tumor in the patient being performed TURBt recurred 4 months after operation,and TURBt again,hitherto no tumor recurrence by follow-up.The tumors in the patients with partial cystectomy(following up 15 months) and orthophoria ileal conduit(9 months) have not recurred to this day.During follow-up,renal functions of all the patients are normal.Conclusion After excluding rejection,pristine cystoscopy is essential to the patients with hematuria and incurable urinary tract infection.Operation is the chief method to the bladder tumors after kidney transplantation,the effect of radical cystectomy and orthophoria ileal conduit is fine.It is feasible to decrease immune depressants after operation.