摘要
目的 探讨肾移植术后患者自身肾细胞癌的诊断和治疗策略. 方法 2001年8月至2010年3月,我院共开展尸体肾移植278例,其中4例（1.4％）受者术后随访检出自身肾细胞癌.另有9例肾移植术后自身肾细胞癌患者为外院转入.13例患者中男9例,女4例.年龄34 ～ 65岁,平均48岁.均为单侧发病,左侧8例,右侧5例.肾移植术后至发现肾癌时间为2.5～6.1年,平均4.2年.均行根治性肾切除术,其中开放手术11例、后腹腔镜下手术2例.围手术期患者免疫抑制剂应用方案不变. 结果 手术时间为110～ 180 min,平均142 min.住院时间9～25 d,平均14 d.13例患者均未出现排斥反应,彩色多普勒超声检查监测移植肾血流良好,围手术期血肌酐稳定.肾癌TNM分期：T1aN0M0期7例,T1bN0M0期5例,T2aN0M0期1例.术后病理检查结果：乳头状肾细胞癌7例,透明细胞癌4例,嫌色细胞癌2例.13例术后随访18～72个月,平均40个月.术后20个月死于肺部感染1例;术后35个月死于心血管意外1例;术后18个月失访1例;术后12个月对侧肾脏出现肾癌1例,行对侧根治性肾切除术,术后随访24个月,无瘤生存;无瘤生存9例. 结论 对肾移植术后患者自身肾细胞癌行根治性肾切除术安全、有效,围手术期继续使用免疫抑制治疗,对移植肾无不良影响.重视肾移植受者自身肾脏的随访,有助于早期发现肾移植术后肾癌.
Objective To explore the diagnosis and surgical treatment of native renal cell carcinoma in transplant recipients.Methods Thirteen patients with native renal cell carcinoma after renal transpantantion were retrospectively analyzed.Of the patients,9 were male and 4 were female.The mean age was 48 years （range,34 to 65）.The mean time between renal transplantation and native renal cell caicinoma was 4.2 years （range 2.5 to 6.1）.Radical nephrectomy was performed without stopping immunosuppression in the 13 cases.Eleven cases underwent open operation and the other 2 cases underwent retroperitoneal laparoscopy.Results The mean operative time was 142 min （range,110-180 min）.The mean hospital stay was 14 d （range,9-25 d）.There were no episodes of rejection,dialysis,second operation,or injury to the transplanted kidney.Color Dopplar ultrasonography showed good blood flow of transplanted kidneys,and the serum creatinine of 13 cases was stable in perioperative period.Seven patients were T1aN0M0,5 patients were stage T1bN0M0,and 1 was T2aN0M0.The distribution of native renal cell carcimoma was as follows：7 papillary,4 clear cell,and 2 chromophobe.The patients were followed up for 18-72 months （mean,40 months）.One patient died of pulmonary infection after 20 months since radical nephrectomy and 1 patient died of angiocardiopathy after 35 months.Contralateral kidney cancer was found 12 months later in 1 case,and radical nephrectomy was performed.The patient survived with tumor-free for 24 months.The other 10 patients survived with tumor-free,while 1 patient was lost after 18 months.Conclusions Radical nephrectomy could be safely implemented for native renal cell carcinoma of renal recipients without jeopardizing their grafts by stopping immunosuppression.Ultrasonography is recommended before and after renal transplantation,and the follow-up of not only the transplanted kidney,but also the native kidneys of renal recipients should be well recognized.Therefore the native renal cell carcinoma can be found as soon as possible.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2014年第1期28-31,共4页
Chinese Journal of Urology
关键词
癌
肾细胞
肾移植
肾切除术
治疗
Carcinoma, renal cell
Kidney transplantation
Nephrectomy
Treatment
