CAJ | 학술논문

目的分析肾移植受者并发自体泌尿系统恶性肿瘤的临床特征.方法回顾性分析单中心1945例肾移植受者的临床资料,其中发生自体泌尿系统恶性肿瘤22例(发生率为1.13％),占所有恶性肿瘤的56.4 ％(22/39).22例中肾乳头状腺癌、肾乳头状细胞癌、肾血管肉瘤各1例;肾盂移行细胞癌1例,肾盂输尿管移行细胞癌6例,输尿管移行细胞癌7例,肾盂输尿管膀胱移行细胞癌1例;膀胱恶性肿瘤4例(包括膀胱移行细胞癌3例、膀胱交界恶性肿瘤1例).22例中,以肉眼血尿为主要症状者17例,2例反复出现镜下血尿,只有3例无明显临床症状.患者的发病年龄为(54.3±12.3)岁,诊断肿瘤的中位时间为移植术后53个月.10例采用环孢素A+硫唑嘌呤+泼尼松预防排斥反应,12例采用环孢素A+吗替麦考酚酯+泼尼松.所有患者均接受手术治疗,其中3例肾脏恶性肿瘤患者接受了根治性肾切除手术,15例肾孟、输尿管肿瘤患者接受患侧肾、输尿管切除并膀胱袖状切除,4例膀胱恶性肿瘤患者中,3例接受经尿道膀胱肿瘤电切术,1例行膀胱部分切除术.结果随访2～97个月,死亡9例,死亡时间为肿瘤手术后6～97个月,死亡原因为骨转移1例,肺转移1例,脑转移2例,肝转移2例,全身广泛转移3例.随访截止时存活13例,存活时间最长者为单纯膀胱肿瘤患者,存活92个月,存活超过4年者4例,存活超过1年者5例.结论自体泌尿系统恶性肿瘤是肾移植术后的一个重要并发症;无痛性肉眼血尿是最常见的症状;根治性手术切除是最主要的治疗手段.
목적 분석신이식수자병발자체비뇨계통악성종류적림상특정.방법 회고성분석단중심1945례신이식수자적림상자료,기중발생자체비뇨계통악성종류22례(발생솔위1.13％),점소유악성종류적56.4 ％(22/39).22례중신유두상선암、신유두상세포암、신혈관육류각1례;신우이행세포암1례,신우수뇨관이행세포암6례,수뇨관이행세포암7례,신우수뇨관방광이행세포암1례;방광악성종류4례(포괄방광이행세포암3례、방광교계악성종류1례).22례중,이육안혈뇨위주요증상자17례,2례반복출현경하혈뇨,지유3례무명현림상증상.환자적발병년령위(54.3±12.3)세,진단종류적중위시간위이식술후53개월.10례채용배포소A+류서표령+발니송예방배척반응,12례채용배포소A+마체맥고분지+발니송.소유환자균접수수술치료,기중3례신장악성종류환자접수료근치성신절제수술,15례신맹、수뇨관종류환자접수환측신、수뇨관절제병방광수상절제,4례방광악성종류환자중,3례접수경뇨도방광종류전절술,1례행방광부분절제술.결과 수방2～97개월,사망9례,사망시간위종류수술후6～97개월,사망원인위골전이1례,폐전이1례,뇌전이2례,간전이2례,전신엄범전이3례.수방절지시존활13례,존활시간최장자위단순방광종류환자,존활92개월,존활초과4년자4례,존활초과1년자5례.결론 자체비뇨계통악성종류시신이식술후적일개중요병발증;무통성육안혈뇨시최상견적증상;근치성수술절제시최주요적치 료수단.
Objective To analyze the epidemiographic features of urological de novo malignant tumor in kidney transplant recipients in the General Hospital of Jinan Military Command.Methods The clinical data of 1945 patients who received kidney transplantation between September 1978 and December 2009 were retrospectively studied.Among 1945 recipients,22 cases were diagnosed as having urological de novo malignant tumors ( incidence:1.13％ ),including renal papillary adencaicinoma (n =1 ),papillary renal cell carcinoma (n =1 ),renal hemangiosarcoma (n =1 ) ; pelvic transitional cell carcinoma (TCC) (n =1 ),pelvic and ureter TCC (n =6),ureter TCC (n =7),pelvic and ureter and urinal bladder TCC (n =1 ),4 cases of bladder malignant tumors (including 3 cases of bladder TCC and 1 case of borderline bladder tumor).Of the 22 cases,17 had a main clinical manifestation of gross hematuria and 2 had microscopic hematuria,and the rest 3 had no obvious symptom.The average age at diagnosis of these 22 cases was 54.3 ± 12.3 years,with a mean time of 53 months after kidney transplantation.Ten cases received immunosuppressive treatment by using cyclosporine A (CsA) + azathioprine (Aza) + prednisone (Pred),while the remaining 12 received CsA + MMF + Pred.Surgical treatment was carried out in all cases:radical nephrectomy was conducted for 3 cases of renal carcinoma; total resection of kidney,ureter and sleeve-shaped resection of bladder in affected side were conducted for the 15 cases of pelvis or ureter carcinoma; for the 4 cases of bladder carcinoma,transurethral resection of bladder tumor was conducted for 3 cases while partial cystectomy was conducted for the other one case.Results During a follow-up period of 2 to 97 months,there were 9 deaths 6 to 97 months after toumorectomy.One died of bone metastasis,one pulmonary metastasis,two brain metastasis,two hepatic metastasis,and three extensive metastatic tumor soon after the diagnosis.Thirteen patients survived through the follow-up,with the longest survival time being 92 months in one patient with urinary bladder tumor.Four patients survived longer than 4 years,and 5 cases longer than 1 year.Conclusion Urological de novo malignant tumor is an important complication after renal transplantation with a main clinical manifestation of painless gross hematuria,and surgical resection is the most important treatment.