CAJ | 학술논문

目的：观察肾移植术后并发尿路上皮癌患者行静脉化疗的副作用和临床疗效。方法回顾分析7例肾移植受者并发尿路上皮癌的患者接受吉西他滨联合顺铂方案（GC ）静脉化疗的临床资料，患者均为女性，年龄范围32～67岁。肾盂、输尿管及膀胱多发癌4例，肾盂癌2例，膀胱癌1例。1例患者在术前接受新辅助化疗，其余6例为术后辅助化疗，化疗方案为：吉西他滨700～800 mg／m2第1、8、15天静脉滴注，顺铂50～60 mg／m2第2天静脉滴注。每4周重复一次，共2～4个周期，7例患者共接受14个周期化疗。结果化疗药的近期毒副反应主要表现为血液学毒性7例（100％）、消化道反应5例（71％）、脱发2例（28％）、尿蛋白1例（14％），化疗1个周期后出现移植肾功能受损1例（14％）。所有患者随访2～11个月：其中1例患者对侧肾盂出现新的尿路上皮癌，1例患者腰大肌转移灶增大，病情恶化后死亡；其余5例患者近期随访无明显异常。结论肾移植受者合并浸润性尿路上皮癌可选择GC方案静脉化疗，但化疗药和免疫抑制剂的同时作用常导致较严重骨髓抑制，需要减少化疗药用量，并进一步调整免疫抑制剂，及时给予升白细胞和血小板治疗，患者可以基本耐受毒副作用，但远期疗效还需进一步观察。
목적：관찰신이식술후병발뇨로상피암환자행정맥화료적부작용화림상료효。방법회고분석7례신이식수자병발뇨로상피암적환자접수길서타빈연합순박방안（GC ）정맥화료적림상자료，환자균위녀성，년령범위32～67세。신우、수뇨관급방광다발암4례，신우암2례，방광암1례。1례환자재술전접수신보조화료，기여6례위술후보조화료，화료방안위：길서타빈700～800 mg／m2제1、8、15천정맥적주，순박50～60 mg／m2제2천정맥적주。매4주중복일차，공2～4개주기，7례환자공접수14개주기화료。결과화료약적근기독부반응주요표현위혈액학독성7례（100％）、소화도반응5례（71％）、탈발2례（28％）、뇨단백1례（14％），화료1개주기후출현이식신공능수손1례（14％）。소유환자수방2～11개월：기중1례환자대측신우출현신적뇨로상피암，1례환자요대기전이조증대，병정악화후사망；기여5례환자근기수방무명현이상。결론신이식수자합병침윤성뇨로상피암가선택GC방안정맥화료，단화료약화면역억제제적동시작용상도치교엄중골수억제，수요감소화료약용량，병진일보조정면역억제제，급시급여승백세포화혈소판치료，환자가이기본내수독부작용，단원기료효환수진일보관찰。
Objective To evaluate the clinical efficacy and side effects of intravenous chemotherapy in renal transplant recipients with urothelial carcinoma .Methods A total of 7 female renal transplant recipients aged 32-67 years with concur‐rent urothelial carcinoma receiving gemcitabine combined cisplatin (GC) scheme .Of all patients ,one received neoadjuvant chemotherapy and others chemotherapy after resection of tumors . The chemotherapy was:gemcitabine 700 -800 mg/m2 , ivgtt ,d1 ,d8 ,d15 ,cisplatine 50‐60 mg/m2 ivgtt ,d2 .Patients received the next chemotherapy cycle after 2 weeks of interval and a total of 2 to 4 cycles ,and altogether 14 cycles of chemotherapy were finished .Results The short‐term toxicity includ‐ed hematology toxicity 100% (7/7) ,digestive discomfort 71% (5/7) ,hair loss 28% (2/7) ,and proteinuria 14% (1/7) .The function of transplant kidney was impaired in one patient after one cycle of chemotherapy .During the follow‐up of 2 to 11 months ,new urothelial carcinoma appeared in one case in the off side of the renal pelvis and one patient died of metastasis in the psoas major .No obvious abnormalities were found in the other 5 patients . Conclusions Renal transplant recipients with muscle invasive urothelial carcinoma can choose GC scheme of intravenous chemotherapy ,but the effect of chemothera‐peutic drugs and the immune inhibitors often leads to severe myelosuppression .The dosage of the chemotherapeutic drugs and immune inhibitors should be reduced and decrease of white blood and platelets should be controlled in time .With careful man‐agement ,patients can tolerate side effects ,but the long‐term effect still needs further observation .