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目的 由于肾移植技术日益成熟,移植肾存活的时间不断延长,因而肾移植后机体其它器官或部位的恶性肿瘤发生率有上升趋势,作者对肾移植后并发舌癌在临床有效的治疗方法上进行了探索、研究。方法 本组3例肾移植后并发舌癌的患者,均为男性,平均年龄47.5岁,肾移植术后平均9年发生舌癌,左侧舌缘部2例,左右侧多灶性舌缘1例,所有病例均被病理证实。结果 除一例患者伴全身骨转移未手术外(一年后死亡),均被减少免疫抑制剂量,同时采用化疗,手术,放疗。随访期2～3a,均未发现肿瘤局部复发和全身远处转移。结论 肾移植术后并发舌癌的患者,由于长期使用免疫抑制剂,对肝脏、凝血、免疫系统都有不同损害,所以在临床治疗上提出:(1)肾移植术后患者除移植肾功能定期复查外,全身系统检查是必要的,能及早发现和治疗癌肿;(2)手术治疗仍为肾移植后并发舌癌主要治疗手段,辅以化疗和放疗;(3)手术范围不要因机体免疫情况差而保守手术范围,否则将引发肿瘤的复发和加速肿瘤的全身远处转移;(4)在彻底治疗癌肿的原则下,尽可能保留移植肾的存活——即低免疫状态。
Objective Because the kidney transplantation technology has become increasingly mature, the survival time of transplanted kidneys has been prolonged, and the incidence of malignant tumors in other organs or parts of the body after renal transplantation has increased. The authors conducted a clinically effective treatment for tongue cancer after renal transplantation. Exploring and researching. Methods Three patients with tongue cancer after kidney transplantation in this group were all males, with an average age of 47.5 years. Tongue cancer occurred after 9 months of renal transplantation. There were 2 cases of the left margin of the tongue, and the left and right multifocal tongue margin 1 In all cases, all cases were confirmed by pathology. Results Except for one patient with systemic bone metastasis who had not had surgery (one year later died), the amount of immunosuppressive agent was reduced and chemotherapy, surgery, and radiotherapy were used. During the follow-up period of 2 to 3 years, no local tumor recurrence or distant metastasis was found. Conclusion The patients with tongue cancer after kidney transplantation have different damage to the liver, coagulation and immune system due to the long-term use of immunosuppressive agents. Therefore, in clinical treatment, we propose: (1) Renal transplantation function after renal transplantation After the review, systemic examination is necessary to detect and treat cancers early; (2) Surgical treatment is still the main treatment for tongue cancer after kidney transplantation, supplemented by chemotherapy and radiotherapy; (3) The scope of surgery should not be due to immune Poor condition and conservative surgical range, otherwise it will lead to tumor recurrence and accelerate the body’s distant metastasis of the tumor; (4) Under the principle of complete treatment of cancer, as much as possible to retain the survival of the transplanted kidney - the low immune status.