摘要目的 探讨肾移植术后发生恶性肿瘤的临床特点和诊治方法.方法 回顾性分析1991年5月至2016年10月我们收治的24例肾移植术后发生恶性肿瘤患者的临床资料.男14例,女10例.年龄42~61岁,平均54.5岁.22例移植前行血液透析,时程6~46个月,平均14.6个月;2例行腹膜透析,时程15个月.19例为首次移植,5例为二次移植.本院肾移植术后发生肿瘤13例,发生率2.9%(13/445).24例中19例为尿路上皮癌,占79%(9例肾盂癌合并输尿管尿路上皮癌,8例原发输尿管尿路上皮癌,2例原发膀胱尿路上皮癌),另有移植肾和原肾的透明细胞癌各1例,甲状腺癌、结肠癌、淋巴瘤各1例.结果 除1例淋巴瘤患者行化疗外,其余23例均行肿瘤根治术.21例泌尿系肿瘤患者中,2例行开放性手术(1例行全泌尿系同期根治性切除术,1例移植肾肿瘤部分切除术),2例行膀胱癌经尿道电切术,17例行腹腔镜下肾盂癌、输尿管癌根治术.3例患者于1年内复发行二次手术、2例患者二次复发行第3次手术.随访18例至今术后生存情况良好;另有5例术后肿瘤复发,3年内死亡.结论 移植术后患者高发恶性肿瘤,与其免疫抑制治疗和肾移植术的影响密切相关.肾移植后发生的恶性肿瘤主要为泌尿系肿瘤.治疗关键在于早期发现、早期治疗.

abstractsObjective To analyze and summarize the risk factors and treatment options of post-renal transplantation. Methods We reviewed 445 renal transplant cases from May 1991 to October 2016 from our hospital. And we had 24 patient received renal transplantation elsewhere who developed malignant tumor afterwards. Among them, 14 patients were male, and 10 patients were female. The age ranged from 42 to 61 years old, with an average age of 54.5 years. 22 patients underwent hemodialysis, with an average of 14.6 months; 2 patients underwent peritoneal dialysis, and the duration is 15 months. 19 patients underwent the transplant for the first time, and 5 patients underwent second transplant. 13 of them developed tumors, and the incidence is 2.9%. In the 24 tumor patients: 19 were urothelial cancer, accounting for 79% (9 renal pelvis and ureter cancer, 8 primary ureter urothelial cancer and 2 primary bladder urothelial cancer), transplant kidney cancer 1 case, thyroid cancer 1 case, colon cancer 1 case and lymphoma 1 case. We analyzed the incidence rate of tumor, type of tumor, time to malignant tumor after surgery, time to diagnosis of tumor after surgery, usage of immune-suppressive medications and prognosis to stratify risk factors of malignant tumor development.Results Only 1 patient with lymphoma underwent chemotherapy, other 23 patients underwent radical operations. All the patients underwent eradicative surgery of malignant tumor, except one patient with lymphoma underwent chemotherapy. Among the 21 patients with urinary system cancers: 2 patients underwent open surgeries (1 patient underwent semi-urinary system resection, 1 patient underwent transplant kidney partial resection), 2 patient underwent TURBT, 17 patients underwent laparoscopic renal pelvis and ureter kidney resection. 3 patients underwent secondary TURBT in one year, 2 patients underwent 3 operations due to recurrent. 18 of them remain healthy; 5 patients had tumor recurrence after the surgery and are deceased 3 years later.Conclusions Post-transplantation patients are susceptible to malignant tumor development, which is closely related to the use of immune suppressant after transplantation. The key to optimal treatment is to detect tumor at an early stage.