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目的探讨妇科恶性肿瘤患者及妇科恶性肿瘤合并肾脏疾病患者化疗期间出现肾功能损害的临床特点及处理。方法收集2000年5月—2016年4月于北京大学人民医院诊治的化疗期间出现肾功能损害的妇科恶性肿瘤患者共59例，回顾性分析其临床特点及处理。根据化疗前是否合并肾脏基础疾病将59例患者分为两组，A组：化疗前无肾脏基础疾病且肾功能正常，共35例；B组：化疗前合并肾脏基础疾病，共24例，其中化疗前肾功能正常者10例、肾功能损害者14例。结果（1）化疗期间发生的肾功能损害的程度：A组35例患者中，化疗期间发生轻度、中度、重度肾功能不全分别为24例（69%）、3例（9%）、1例（3%），肾功能衰竭（肾衰）6例（17%），可逆性肾功能不全1例（3%）。B组24例患者中，10例化疗前肾功能正常的患者，化疗期间发生轻度、中度、重度肾功能不全分别为7例（7/10）、1例（1/10）、1例（1/10），肾衰1例（1/10）；14例化疗前有肾功能损害的患者，化疗期间由轻度肾功能不全转为肾衰1例（1/14）、肾功能损害病情稳定9例（9/14）、肾功能损害好转4例（4/14）。（2）化疗期间发生肾功能损害时的化疗疗程数：化疗前肾功能正常的45例（包括A组35例、B组化疗前肾功能正常者10例）患者中，肾功能损害发生于术中腹腔化疗者11例（24%），第1～3个疗程者20例（44%），第4～8个疗程者10例（22%），第8个疗程后4例（9%）。B组中化疗前有肾功能损害的14例患者中，1例（1/14）于化疗第3个疗程由轻度肾功能不全转为肾衰，9例（9/14）肾功能损害病情稳定，4例（4/14）于第1～3个疗程肾功能损害好转，且之后也无加重。（3）发生肾功能损害后化疗方案的调整情况：化疗前肾功能正常的45例患者，化疗期间发生肾功能损害前均采用以铂类药物为基础的化疗，发生肾功能损害后，均采用细胞保护剂（氨磷汀），化疗方案中使用顺铂的44例患者中，24例改为卡铂或奥沙利铂，4例改为紫杉醇单药化疗，2例化疗与透析序贯进行，7例进行化疗药物剂量调整，其余7例因肾功能损害较轻，仅使用了细胞保护剂，未经特殊处理。最终有37例患者顺利完成化疗，7例患者因肾损害病情未见好转甚至肾衰导致不耐受而终止化疗。化疗结束后随访，37例顺利完成化疗的患者其5年无瘤生存率为64.9%，7例未完成化疗的患者其5年内无瘤生存率为14.3%。B组中化疗前有肾功能损害的14例患者，其中4例肾功能损害较轻者采用以顺铂为主的联合化疗，6例采用紫杉醇+卡铂（TC）方案化疗（其中有2例患者采用TC方案化疗与透析序贯进行），3例采用紫杉醇单药化疗，1例采用奥沙利铂+替加氟+亚叶酸钙（FOLFOX）方案化疗，14例患者均顺利完成化疗；化疗结束后随访其5年内无瘤生存率为57.1%。结论化疗药物可诱发妇科恶性肿瘤患者发生急性肾功能损害，甚至导致肾衰，且可使妇科恶性肿瘤合并肾功能损害的患者病情加重。因此，应重视化疗对妇科恶性肿瘤患者肾功能影响的防治，尤其应重视合并肾脏疾病且有肾功能损害患者的化疗方案的选择。

Objective To analysis the patients with gynecological malignant tumor and gynecologic malignant tumor complicated with kidney diseases appeared renal dysfunction during chemotherapy, and protect the residual renal function. Methods A retrospective analysis of 59 patients with gynecological malignant tumor with abnormal renal function during chemotherapy in Peking University People′s Hospital from May 2000 to April 2016. According to whether or not complicated with kidney diseases and renal dysfunction before chemotherapy, all cases were divided into two groups. Group A was the patients without kidney diseases and with normal renal function before chemotherapy (n=35), while group B with kidney disease before chemotherapy (n=24), included 10 cases of normal renal function and 14 cases of abnormal renal function. Results (1)During chemotherapy there were respectively 24 cases(69%) occurred mild renal dysfunction, 3 cases(9%) of moderate renal dysfunction, 1 case(3%) of severe renal dysfunction, 6 cases (17%) of renal failure, 1 case(3%) of reversible renal dysfunction in group A. While, among 10 cases of normal renal function patients in group B, there were 7 cases(7/10) occurred mild renal dysfunction, 1 case (1/10) of moderate renal dysfunction, 1 case(1/10) of severe renal dysfunction, 1 case(1/10) of renal failure. Among 14 cases with abnormal renal function in group B, there were respectively 1 patient(1/14) who renal dysfunction was from mild to renal failure, 9 cases(9/14) of stable renal function and 4 cases(4/14) of severe renal dysfunction became improved after chemotherapy.(2)Renal dysfunction occurred and the number of chemotherapy course:45 patients with normal renal function (including 35 cases in group A, 10 cases with normal renal function in group B), there were 11 cases(24%) occurred renal dysfunction after intraperitoneal chemotherapy, 20 cases(44%) occurred in the 1-3 courses of treatment, 10 cases(22%) occurred in the 4-8 courses, while 4 cases(9%) appeared after 8 courses. Among 14 patients with abnormal renal function before chemotherapy in group B, there were respectively 1 patient(1/14) with renal dysfunction was from mild to renal failure occurred at the third courses of chemotherapy, 9 cases(1/14) of stable renal function, 4 cases(4/14) of severe renal dysfunction became improved from the 1-3 course of chemotherapy.(3)The regimen adjustment of chemotherapy before and after the occurrence of renal dysfunction: 45 patients with normal renal function, the platinum-based chemotherapy regimen were used before the occurrence of renal dysfunction. After renal dysfunction occurred, all the patients were received chemoprotective agent amifostine. Among 44 cases with cisplatin-based chemotherapy, 24 cases of them were replaced with carboplatin or oxaliplatin, 4 cases of them just treated with paclitaxel, 2 cases performed chemotherapy and dialysis sequneced, 7 cases adjusted dosage,while the other cases did not any special treatment because of mild renal dysfunction. Finally, there were 37 cases successfully completed the chemotherapy, while 7 cases could not completed chemotherapy, because renal dysfunction was aggravated or renal failure. The 5 year survival rate of 37 cases was 64.9%,7 cases that did not completed chemotherapy was 14.3%. Fourteen cases with renal dysfunction in group B, 4 cases of them with mild received cisplatin-based chemotherapy, 6 cases used paclitaxel combined carboplatin regimen, including 2 cases with chemotherapy and dialysis sequenced, 3 cases adjusted dosage paclitaxel, 1 case performed modify FOLFOX regimens chemotherapy (tegafur+oxaliplatin+calcium folinate). All 14 patients were successfully completed chemotherapy. The 5 year survival rate was 57.1%. Conclusions Chemotherapy drugs, especially for platinum-based regimens could induce acute renal insufficiency, even aggravated or lead to renal failure in patients with gynecological cancer. Therefore, we should pay attention to the prevention and treatment of renal dysfunction in patients with gynecological malignant tumor during chemotherapy, adjustment the chemotherapy regimen in patients with renal dysfunction.