肾移植后直肠癌的诊治及预后分析

 【摘要】　目的　探讨肾移植后结直肠癌的诊断与治疗，并对其预后进行分析。方法　1035例次的肾移植患者中，4例患直肠癌。3例行全直肠系膜切除（TME）的直肠癌前切除术（AR）或腹会阴联合切除术（APR），其中2例术后接受卡培他滨正规辅助化疗，1例术后拒绝接受任何辅助治疗，但在术后29个月发现肝、肺多发转移，予姑息化疗和最佳支持治疗。1例在诊断时即为直肠癌伴肝脏多发转移，行姑息化疗和最佳支持治疗。结果　术后接受化疗的2例分别为术后8个月和21个月，已完成术后6个月的常规化疗，近期随访显示一切正常。其他2例分别于开始治疗后5个月和31个月时死于疾病进展。结论　尽管肾移植患者患结直肠癌的预后不佳，但只要一般情况和移植器官的功能良好，就应该给予积极的抗肿瘤治疗，包括手术和辅助治疗。对肾移植患者进行定期结直肠癌筛检是十分必要的。

Diagnosis, treatment and prognosis of rectal cancer after renal transplantation

Objective To investigate the diagnosis,the treatment methods and the prognosis of rectal cancer patients after renal transplantation.Methods Four patients with rectal cancer were found in 1035 renal transplantation recipients.Three of four patients were treated with anterior resection (AR) or abdomenoperineal resection (APR) with total mesorectal excision (TME).The two patients accepted regular adjuvant chemotherapy for six months period after surgery,but one patient rejected to accept any chemotherapy after surgery.Otherwise,one patient was only treated with chemotherapy and best support therapy for diagnosed as rectal cancer with multiple liver metastases.Results Two patients were fine to be followed up,8 months and 21 months after rectal resection respectively.Two other patients eventually died of metastasized cancer 5 months and 31 months respectively after therapy had been initiated.Conclusion Transplantation patients should receive standard oncology treatment,including operation and adjuvant treatment,so long as their general condition and organ graft functions allow to do so,although a higher degree of morbidity might be encountered,and periodical colorectal screening should be performed before and after renal transplantation.