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目的:分析、总结肾移植术后发生恶性肿瘤的危险因素和诊治方法。方法:回顾北京大学人民医院自1991年5月至2011年3月收治的435例肾移植术受者中发生恶性肿瘤的12例患者,以及外院接受肾移植后发生恶性肿瘤的2例患者资料,对肿瘤发生率、恶性肿瘤类型、术后肿瘤诊断时间、免疫抑制剂应用情况及预后等进行多因素分析。结果:本院肾移植术后发生肿瘤12例,发生率2.8%。全部14例恶性肿瘤中,11例为尿路上皮癌,占78%(6例肾盂癌合并输尿管尿路上皮癌、2例原发输尿管尿路上皮癌、3例原发膀胱尿路上皮癌),另外甲状腺癌、结肠癌、淋巴瘤各1例。除1例淋巴瘤患者行化疗外,其余13例患者均行肿瘤根治术,其中10例术后情况良好,2例于1年内复发行二次手术(其中1例复发后肿瘤较大失去手术机会于半年后死亡),另有1例反复复发术后3年死亡。结论:肾移植术后的患者高发恶性肿瘤,与其免疫抑制治疗和肾移植术的影响密切相关。肾移植后发生恶性肿瘤(78%为泌尿系肿瘤)的危险性随患者存活时间的延长而迅速增加,治疗关键在于早期发现、早期治疗,因此对于术后无痛性肉眼血尿、无明显诱因腰部胀痛等,特别是发生肾或输尿管积水、感染等情况,应予以高度重视。
Objective: To analyze and summarize the risk factors and diagnosis and treatment of malignant tumor after renal transplantation. Methods: To review the data of 12 patients with malignant tumors in 435 renal transplant recipients who were admitted to Peking University People’s Hospital from May 1991 to March 2011, and 2 patients who developed malignant tumors after kidney transplantation in the outpatient department, Multivariate analysis was made on the incidence of cancer, the type of malignant tumor, the time of postoperative tumor diagnosis, the application of immunosuppressive agents and prognosis. Results: 12 cases of tumors occurred after renal transplantation in our hospital, the incidence rate was 2.8%. Of the 14 malignant tumors, 11 were urothelial carcinomas, accounting for 78% (6 with renal pelvic carcinoma associated with urothelial carcinoma, 2 with primary urothelial carcinoma and 3 with primary urothelial carcinoma) , Another thyroid cancer, colon cancer, lymphoma in 1 case. In addition to chemotherapy in 1 patient with lymphoma, the remaining 13 patients underwent radical resection of the tumor, of which 10 were in good condition and 2 were relapsed within 1 year undergoing second surgery (one of them had a major loss of chance of surgery after the recurrence) Died in six months), another case of repeated recurrence after 3 years of death. Conclusions: High-grade malignant tumors in patients after kidney transplantation are closely related to their immunosuppressive therapy and renal transplantation. The risk of malignant tumors (78% of urological tumors) after renal transplantation increased rapidly with the survival time of patients, the key lies in the early detection and early treatment, so no postoperative painful gross hematuria, no obvious incentive for the waist Pain and so on, especially in case of renal or ureteral hydronephrosis, infection, etc., should be highly valued.