肾移植术后并发自体尿路上皮多器官癌6例诊治研究

目的：探讨肾移植后并发自体尿路上皮多器官癌的诊治方法。方法：回顾性分析6例肾移植术后自体尿路上皮多器官癌的临床资料。结果：发现6例中1例为亲属肾移植。5例临床表现为肾移植术后2～48个月出现间歇性血尿，1例B超发现膀胱占位病变。6例均为非同时发生的移行细胞癌，非同时发生肿瘤的时间为1．5～16个月。6例患者因肿瘤复发或新发而接受2～5次肿瘤切除术，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。术后通过膀胱灌注给予丝裂霉素、吡柔比星、表阿霉素等进行化疔。治疗效果比较满意。结论：肾移植术后的尿路上皮多器官癌往往进展快，易扩散和转移，预后较差。对肾移植后并发自体尿路上皮多器官癌应高度重视，严把受体关，密切随访，早期诊断，积极治疗，慎重对待移植肾切除。

Diagnosis and Treatment of Multifocal Urothelial Carcinomas of Kidney Recipients following Renal Transplantation: Study of 6 Cases

Objective： To discuss the diagnosis and treatment of multifocal urothelial carcinomas in kidney transplant recipients. Methods：A retrospective analysis was undertaken on 6 cases of multifocal urothelial carcino mas following renal transplantation. Results：6 patients were diagnosed with multifocal urothelial carcinomas, in cluding 1 case of living related renal transplantation. 5 cases manifested with painless gross hematuria 2 48 months after renal transplantation, 1 patient was diagnosed as having bladder tumor by B-mode ultrsound. They had transitional cell carcinoma unsimultaneously, which happened from 1.5 months to 16 months, and which accepted resection of tumor 2 to5 times because of recurrence or new tumor. 1 case was accepted radical cystectomy and cutaneous ureterostomy of the renal allograft, 1 case was accepted radical cystectomy, cutaneous ureterostomy of the renal allograft and radical urethrectomy. Intravesical chemotherapy was started and bladder instillations with mito mycin, pirarubicin, epirubicin ect were adjusted 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 carcinoma, and easy to metastasis, mostly have unsatisfactory prognostic. Kidney recipients with multifocal urothelial carcinomas should be attach great importance. Strict examination of receptor , close follow-up, early diagnosis, active treatment should be done carefully. Transplant nephrectomy should be managed cautiously.