肾移植术后并发尿路上皮肿瘤(附25例报告)

目的 探讨肾移植术后并发尿路上皮肿瘤的临床特点及其诊治方法.方法 回顾性分析1998年～2006年间肾移植术后发生尿路上皮肿瘤的临床资料25例.就患者性别、移植时年龄、导致肾功能不全的原发病、移植后肿瘤发生的时间、临床症状、肿瘤发生部位及转归等项目进行临床分析.所有病例移植前均排除肿瘤.肿瘤均经影像学和膀胱镜等检查方法诊断.22例患者行手术治疗,术后所有患者免疫抑制剂用量减少1/3并辅以局部灌注化疗.结果 本组25例患者中男4例,女21例;移植时患者平均年龄55.1岁;原发病为慢性间质性肾炎的患者19例;术后发生肿瘤的时间距肾移植时间平均26个月;临床表现为肉眼血尿或镜下血尿25例,反复泌尿系感染10例,肾盂输尿管积水者12例;肿瘤为多发者22例;移植肾同侧有上尿路肿瘤者16例;3例行姑息性治疗的晚期肿瘤患者分别于发现肿瘤5个月、6个月及8个月后死亡,22例手术治疗患者已随访2～7年,18例肿瘤复发,再行手术治疗;所有患者在免疫抑制剂减量期间均未出现急性排斥,肾功能正常.结论 本组显示慢性间质性肾炎导致肾功能衰竭的肾移植患者和女性肾移植患者易发生移植后尿路上皮肿瘤;血尿、泌尿系感染和肾盂积水是常见的症状,多发性和易复发性是另一临床特点;移植肾同侧上尿路较对侧好发肿瘤.

Urothelial carcinoma following renal transplantation(Report of 25 cases)

Objective To summarize features of urothelial carcinoma in renal allograft recipients and investigate the measures of diagnosis and treatment. Methods A retrospective study was undertaken on 25 renal allograft recipients with urothelial carcinoma in our center between 1998 and 2006. To analysis sexuality, age, protopathy, time of the tumor occurred, symptom, the location of tumor and turnover respectively. All the cases didn't have tumor before transplantation. The primary examinational methods are the imaging and cystoscope. Surgical treatment was carried out in 22 cases. All the 22 cases reduced one third of the dosage of immunos.uppressant and performed intravesical instillation chemotherapy. Results There are 4 males and 21 females in the 25cases; The average age is 55.1; There were 19 cases which protopathy were chronic interstitial nephritis(CIN); The interval between tumorigenesis and transplantation was 26 months; There are 25 cases with gross or microscopic hematuria, 10 cases with iterative urinary tract infection, and 12 cases with renal pelvis and ureter stretch; There are 22 cases with multiple tumors and 16 cases with tumor(s) of upper urinary tract the same-side of graft. 3 cases without surgical treatment had died respectively 5, 6 and 8 month after diagnosed. 22 cases with surgical treatment were followed up from 2 to 7 years. 18 cases had tumor recurrence and received operation again. All the patients did not occur the acute rejection during decreased the dosage of immunosuppressant and have normal renal function.Conclusions Renal allograft recipients whose protopathy were chronic interstitial nephritis (CIN) and female recipients may be the risk factors of the disease. The hematuria, urinary tract infection and stretch are common symptoms. The multi-tumor and recurrence are the other clinical features. The upper urinary tract with same-side graft is easy to involve urothelial carcinoma.