论文部分内容阅读
目的:探讨肾移植术后并发泌尿系统肿瘤的相关因素与临床干预措施。方法:报告9例(10次)此种患者的临床资料。9例肾移植术后均行免疫抑制治疗。肿瘤均发生在自体肾、输尿管和膀胱:肾透明细胞癌、肾肉瘤和膀胱腺癌各1例,肾盂输尿管膀胱移行细胞癌6例,其中1例先发生膀胱腺癌后又发生肾盂输尿管移行细胞癌。肿瘤发生于移植术后8~146个月,且8例发生在应用新型免疫抑制剂之后。患者均有服用龙胆泻肝丸或冠心苏合丸史。8例接受了根治性手术,1例未能手术切除。结果:9例随访8~44个月,未能手术切除1例于术后5个月肝转移死亡。1例肉瘤复发后放弃治疗后死亡。1例膀胱肿瘤复发,行膀胱全切腹壁造瘘术,1例腺癌已出现肺和胸膜转移。另5例最后随访时存活良好。结论:肾移植术后并发泌尿系统肿瘤以移行细胞癌为多;可能与服用含马兜铃的中药和应用新型免疫抑制剂有关;根治性手术治疗、减少免疫抑制剂用量和更换免疫抑制剂种类是主要临床干预措施。
Objective: To investigate the related factors and clinical intervention of urinary system tumors after renal transplantation. Methods: Nine patients (10 times) were reported for clinical data. Nine patients underwent immunosuppressive therapy after renal transplantation. Tumor occurred in autologous kidney, ureter and bladder: renal clear cell carcinoma, renal sarcoma and adenocarcinoma in 1 case, 6 cases of renal pelvis and ureter transitional cell carcinoma of the bladder, including 1 case of bladder adenocarcinoma followed by ureteropelvic transitional cell cancer. Tumors occurred 8 to 146 months after transplantation, and 8 occurred after the administration of a novel immunosuppressive agent. Patients have taken Long Dan Xiegan pill or Guanxin Suhewan history. Eight patients underwent radical surgery and one failed surgery. Results: Nine patients were followed up for 8 to 44 months. One patient who failed to be surgically removed died of liver metastasis 5 months after operation. One case of sarcoma died after relapse and gave up treatment. One case of bladder tumor recurrence, bladder resection abdominal wall ostomy, 1 case of adenocarcinoma has lung and pleural metastasis. The other 5 patients survived the last follow-up. Conclusions: There are many cases of transitional cell carcinoma with urinary system tumors after renal transplantation. It may be related to taking traditional Chinese medicine containing Aristolochia and applying new immunosuppressive agents. Radical surgical treatment can reduce the dosage of immunosuppressive agents and change the types of immunosuppressants Is the main clinical intervention.