摘要
目的:探讨肾移植术后新发膀胱肿瘤患者的临床特点、诊治和预后。方法:回顾性研究1997年1月—2022年4月在北部战区总医院(沈阳军区总医院)接受肾移植术后随访的10例新发膀胱肿瘤患者的临床资料。收集并分析患者肾移植手术时年龄、原发病、既往病史、吸烟及饮酒史、肿瘤家族史、新发膀胱肿瘤诊治经过及预后等资料。结果:肾移植术后新发膀胱肿瘤发生率为0.7%(10/1420),男女比例为3∶7,肾移植手术时年龄39~63岁,中位年龄53岁。原发病中未经病理证实的肾小球肾炎5例,高血压肾病1例,高血压肾病合并高尿酸血症1例,不明原因3例。既往均无吸烟史、饮酒史、特殊家族史。从接受肾移植手术至确诊为膀胱肿瘤的时间为7~236个月,中位时间为139个月。患者确诊为膀胱肿瘤后均行经尿道膀胱肿瘤切除术,术后常规使用表柔比星膀胱灌注,后有4例膀胱肿瘤复发。术后病理提示高级别乳头状尿路上皮癌7例,低级别乳头状尿路上皮癌3例。10例患者膀胱肿瘤预后良好,无死亡。移植肾带功9例,失功1例。结论:国内肾移植术后新发膀胱肿瘤发病率及复发率较高,但经积极干预后可获得较好的预后。其起病症状较为隐匿,对于具有致病高危因素的患者应积极进行有效的预防,定期行膀胱镜检查。新发膀胱肿瘤后,可考虑将免疫抑制剂改为西罗莫司。在膀胱灌注时使用卡介苗可能是一种更好的选择,但仍需大量研究进行验证。
Objective To investigate the clinical characteristics,diagnosis,treatment and prognosis of patients with new bladder tumor after renal transplantation.Methods A retrospective study was conducted on the clinical data of 10 patients with new bladder tumor who received kidney transplantation in The Northern Theater Command General Hospital(Shenyang Military Command General Hospital)from January 1997 to April 2022.The age,primary disease,past medical history,smoking and drinking history,family tumor history of the patients at the time of kidney transplantation,diagnosis and treatment of new bladder tumor and prognosiswere analyzed.Results The incidence of new bladder tumor after renal transplantation was 0.7%(10/1420).The ratio of male to female was 3∶7.The patients were 39 to 63 years old at the time of kidney transplantation,with a median age of 53 years.Among the primary diseases,there were 5 cases of glomerulonephritis,1 case of hypertensive nephropathy,1 case of hypertensive nephropathy complicated with hyperuricemia,and 3 cases of unknown cause.All patients had no history of smoking,drinking or special family history.The time from kidney transplantation to diagnosis of bladder tumor ranged from 7 to 236 months,with a median of 139 months.After the diagnosis of bladder tumor was confirmed,all patients underwent transurethral resection of bladder tumor.After receiving routine bladder infusion with epirubicin,4 patients had bladder tumor recurrence.Postoperative pathology revealed 7 cases of high-grade papillary urothelial carcinoma and 3 cases of low-grade papillary urothelial carcinoma.Ten patients had a good prognosis for bladder tumors without death.There were 9 patients with renal graft success and 1 patient with renal graft failure.Conclusion The incidence and recurrence rate of new bladder tumors after renal transplantation are high in China,but the prognosis can be better after active intervention is conducted.The onset symptoms are relatively insidious,so patients with high risk factors should be actively and effectively prevented,and cystoscopy should be performed regularly.Sirolimus may be considered as an immunosuppressant of new bladder tumors occur.BCG may be a better option for bladder perfusion,but more studies are needed.
作者
宋醒
何龙
杨宏伟
SONG Xing;HE Long;YANG Hongwei(Organ Transplant Center,General Hospital of Northern Theater Command,Shengyang,110000,China)
出处
《临床泌尿外科杂志》
CAS
2023年第4期300-304,共5页
Journal of Clinical Urology
基金
辽宁省民生科技计划(No:2021JH2/10300089)。
关键词
肾移植
膀胱肿瘤
预防
治疗
renal transplantation
bladder cancer
prevention
treatment
