目的 分析我院肾移植受者并发泌尿系统恶性肿瘤的特点。方法 对我院1978年6月-2001年12月的2300例肾移植受者进行回顾分析。结果 在2300例中，共发生27例(发生率1．22％)恶性肿瘤，其中泌尿系统恶性肿瘤9例(0．39％，男性6例，女性3例)，占肿瘤发生的1／3，其它肿瘤包括皮肤癌、肝右叶囊性腺癌、肝细胞癌、胃癌、直肠癌、结肠癌、回盲部腺癌、唇癌、舌癌、肺恶性淋巴瘤和乳癌共18例。泌尿系统恶性肿瘤中肾细胞癌1例，双侧肾盂癌2例，单侧肾盂癌3例，输尿管癌1例，膀胱癌2例。平均发病年龄57．5±5．6(49—63)岁，平均术后时间58±18(36—94)个月。6例服用CsA+Aza+Pred，3例服用CsA+MMF+Pred。8例施行了根治性手术，1例术后不久并发脑溢血死亡。结论泌尿系统恶性肿瘤，尤其是移行上皮癌，是肾移植受者的一个重要并发症，其发病率是一般泌尿系统肿瘤病例的10倍，其中肾盂移行细胞癌发生率最高，其次是膀胱移行细胞癌。免疫抑制剂的使用与肿瘤发生密切相关，应定期评估移植受者的免疫状态，重视无痛性肉眼血尿的检查，早期发现肿瘤，及时手术治疗。并减少免疫抑制剂用量。Objectiveter.To analyze the epidemiographic features of urological malignancy in renal allograft recipients (RAR) in a single center Methods A retrospective analysis was made on 2300 patients who received renal allografts from June 1978 to December 2001 and anti-rejection treatment for at least 3 months.Results Of the 2300 recipients, 27 ( 1.22% ) developed malignancies, including 9 patients (0.39% , 6 males and 3 females) with urological tumors and 18 patients with skin carcinoma, right liver lobular cystic adenocarcinoma, hepatocellular carcinoma, gastric cancer, colorectal carcinoma, ileocecal adenoma, lip cancer, and pulmonary lymphoma and breast cancer. The 9 cases of urological malignancies included one case of renal cell carcinoma, 2 cases of bilateral pelvic transitional cell carcinoma (TCC), 3 cases of unilateral pelvic TCC, one case of ureter TCC and 2 cases of bladder TCC. The age at which the diagnosis was made ranged from 49 to 63 years with a mean of 57.5 + 5.6 years, and the mean course of immunosuppressive therapy ranged from 36 to 94 months with a mean of 58 ~ 18 months. Of the 9 patients who developed urological malignancies, 6 had been on a Cyclosporine A + Azalthioprine + Prednisone ( CsA + Aza + Pred) protocol, and 3 on a Cyclosporine A + Mycophenolate Mofetil + Prednisone( CsA + MMF + Pred) protocol. One of the 9 patients died soon after the diagnosis was made, and the remaining 8 patients re-ceived surgical resection. Of them, 8 patients survived well and the other one died from cerebral hemorrhage soon after operation.Conclusion Urological malignancies, especially TCC, is an important complication in renal transplanatation found in this center.The incidence of urological malignancy in RAR is about 10 times that in the general population of Shanghai versus 2 times for other malignancies. Pelvic TCC is the No. one malignancy and bladder TCC the second in RAR. The occurrence of the malignancies in RAR seems to be closely related to the use of immunosuppressive agents. Immunosuppression results in the weakening of immnuologic surveillance function, leading to mutation, aberration and carcinogenesis. The immunological status of patients after renal transplantation should be assessed regularly. Painless macroscopic hematuria should be considered a significant sign in assessing the potential occurrence of urological malignancy in RAR. Treatment includes early diagnosis, timely surgical resection and reduction of immunosuprressive agents.
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