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目的 分析我院肾移植受者并发泌尿系统恶性肿瘤的特点。方法 对我院1978年6月-2001年12月的2300例肾移植受者进行回顾分析。结果 在2300例中,共发生27例(发生率1.22％)恶性肿瘤,其中泌尿系统恶性肿瘤9例(0.39％,男性6例,女性3例),占肿瘤发生的1/3,其它肿瘤包括皮肤癌、肝右叶囊性腺癌、肝细胞癌、胃癌、直肠癌、结肠癌、回盲部腺癌、唇癌、舌癌、肺恶性淋巴瘤和乳癌共18例。泌尿系统恶性肿瘤中肾细胞癌1例,双侧肾盂癌2例,单侧肾盂癌3例,输尿管癌1例,膀胱癌2例。平均发病年龄57.5±5.6(49-63)岁,平均术后时间58±18(36-94)个月。6例服用CsA+Aza+Pred,3例服用CsA+MMF+Pred。8例施行了根治性手术,1例术后不久并发脑溢血死亡。结论 泌尿系统恶性肿瘤,尤其是移行上皮癌,是肾移植受者的一个重要并发症,其发病率是一般泌尿系统肿瘤病例的10倍,其中肾盂移行细胞癌发生率最高,其次是膀胱移行细胞癌。免疫抑制剂的使用与肿瘤发生密切相关,应定期评估移植受者的免疫状态,重视无痛性肉眼血尿的检查,早期发现肿瘤,及时手术治疗,并减少免疫抑制剂用量。
Objective To analyze the characteristics of renal transplant recipients in our hospital with urinary malignancies. Methods A retrospective analysis of 2,300 kidney transplant recipients from June 1978 to December 2001 in our hospital was conducted. Results A total of 27 cases (1.22% incidence) of malignant tumors were found in 2300 cases, including 9 cases of urological malignancies (0.39%, 6 males and 3 females) accounting for one third of the tumors. Other tumors included Skin cancer, right lobe cystadenocarcinoma, hepatocellular carcinoma, gastric cancer, rectal cancer, colon cancer, ileocecal adenocarcinoma, lip cancer, tongue cancer, pulmonary malignant lymphoma and breast cancer. 1 case of renal cell carcinoma, 2 cases of bilateral renal pelvis cancer, 3 cases of unilateral renal pelvis cancer, 1 case of ureteral cancer and 2 cases of bladder cancer. The average age of onset was 57.5 ± 5.6 (49-63) years, with an average postoperative time of 58 ± 18 (36-94) months. 6 patients took CsA + Aza + Pred and 3 patients took CsA + MMF + Pred. Eight patients underwent radical surgery and one died of cerebral hemorrhage shortly after surgery. Conclusions Urinary system malignancies, especially transitional cell carcinomas, are an important complication of renal transplant recipients. The incidence of urinary tract malignancies is 10 times that of urinary system tumors. The incidence of renal pelvis transitional cell carcinoma is the highest, followed by bladder transitional cell cancer. The use of immunosuppressive agents is closely related to tumorigenesis. The immune status of the transplant recipients should be evaluated regularly. Painless gross hematuria should be valued. Early detection of tumors, timely surgical treatment, and reduction of the dosage of immunosuppressants should be performed.