摘要
目的通过对肾移植后并发恶性肿瘤的发病、临床特征、治疗方法及效果进行分析,探讨降低肾移植后肿瘤发生率及提高治疗效果的方法。方法对同种异体肾移植患者476例进行回顾性研究,对患者的年龄、性别、术前透析时间、免疫抑制剂应用情况、肿瘤原发病、发病时间及发生肿瘤后治疗方法和效果进行分析。结果 476例肾移植患者术后共有17例发生恶性肿瘤,发生率为3.57%,其中泌尿系肿瘤11例(肾盂癌4例,输尿管肿瘤3例,膀胱癌4例),占64.7%;消化道肿瘤3例(结肠癌1例,直肠癌2例),占17.7%;肝癌2例,占11.72%;子宫内膜癌1例,占5.88%。肿瘤发病在肾移植术后32-106个月,平均61.4个月。并发肿瘤14例接受手术治疗,2例接受单纯化疗,1例放弃治疗。术后对免疫抑制剂进行减量调整,其中4例改为西罗莫司免疫抑制方案,3例因肿瘤广泛转移死亡,死亡率17.6%。结论肾移植术后患者恶性肿瘤的发生率明显高于正常人群,以泌尿系肿瘤为最多,死亡率较高,早期诊断、早期治疗仍是提高患者生存率的必要措施。
Objective To explore the ways to reduce the incidence of malignant tumors by analyzing the attack, the clinical characteristics, the therapeutic method and the curative effect after renal transplantation. Methods The age, sex, the preoperative dialysis time, the application of immunosuppressant, the primary diseases, the onset time of tumor and the treatment were retrospectively analyzed. Results The in- cidence of malignant tumors in patients after renal transplantation was 3.57%. Urinary tumors occurred in 11 cases （4 cases of renal pelvis carcinoma, 3 cases of ureter tumor and 4 cases of bladder cancer）, ac counting for 64.7%.3 cases had the tumor of digestive system （1 case of colon cancer and 2 cases of rectal cancer）, accounting for 17.7%. 2 cases suffered from liver cancer, accounting for 11.72%. One case got endometrial carcinoma, accounting for 5. 88%. The onset time was between 32 and 106 months, with an average of 61.4 months. 14 patients underwent surgical treatment, 2 cases received pure chemotherapy, and one case gave up treatment. The post-operative immunosuppressant was reduced. 4 cases were treated with sirolimus. 3 cases died of cancer, with the mortality being 17. 6%. Conclusion The incidence of malignant tumor after renal transplantation was significantly higher than that of healthy population, the incidence of urinary cancer as well as its mortality is on the top of the list. Early diagnosis and early treatment are still the necessary measures to improve the survival rate of patients.
作者
谷建营
张维颉
顾润国
GU Jian-ying ZHANG Wei-jie GU Run-guo(Weifang Medical College, Wei fang, China 261053)
出处
《山东医学高等专科学校学报》
2017年第2期113-118,共6页
Journal of Shandong Medical College
关键词
肾移植
恶性肿瘤
免疫抑制剂
发病率
Kidney transplantation
Malignant tumor
Immunosuppressant
Morbidity
