David M, Olbrich C, Neuhaus R, Lichtenegger W
Universitätsklinikum R. Virchow, Geburtshilflich-gynäkologische Abteilung, Freie Universität Berlin.
Geburtshilfe Frauenheilkd. 1995 Aug;55(8):431-4. doi: 10.1055/s-2007-1022815.
After transplantation the necessary immunosuppressive therapy predisposes to the development of de novo cancers. From January 1989 to April 1994 we collected PAR smears of 98 women before and repeatedly after liver transplantation. After surgery all women received as immunosuppressive agents either Cyclosporin A or FK 506 as long-term medication. In seven patients (8.5%) who had a normal cervical cytology before transplantation a suspicious PAP smear was found on average 11 months after transplantation. In five cases a histological verification (exploratory excision, coning of the cervix) was made. In two cases we found a CIN III. Possible causes for the higher incidence of dysplasia of the cervix observed in the transplant patients are discussed. Similar to kidney transplant recipients female liver transplant recipients are at higher risk of developing cervical dysplasias and neoplasias. Accelerated development of malignancy seems likely. The influence on the cervical cells of both immunosuppressive drugs Cyclosporin A and FK 506 seems to be of a similar nature. Recommendations for the gynaecological care of female liver transplant recipients treated with immunosuppressive therapy are given.
移植后,必要的免疫抑制治疗会增加新发癌症的发生风险。1989年1月至1994年4月,我们收集了98名女性在肝移植前后及术后多次的巴氏涂片。术后所有女性均接受环孢素A或FK 506作为长期免疫抑制剂治疗。7例(8.5%)移植前宫颈细胞学检查正常的患者,移植后平均11个月发现可疑巴氏涂片。其中5例行组织学确诊(探查性切除、宫颈锥形切除术)。2例发现为宫颈上皮内瘤变III级。文中讨论了移植患者中观察到的宫颈发育异常发生率较高的可能原因。与肾移植受者相似,女性肝移植受者发生宫颈发育异常和肿瘤的风险更高。恶性肿瘤似乎有加速发展的可能。免疫抑制药物环孢素A和FK 506对宫颈细胞的影响似乎性质相似。文中给出了对接受免疫抑制治疗的女性肝移植受者进行妇科护理的建议。