妇科恶性肿瘤致输尿管梗阻96例临床资料分析

目的探讨妇科恶性肿瘤致输尿管梗阻的姑息手术治疗效果。方法回顾性分析于该院行姑息手术治疗的96例妇科恶性肿瘤致输尿管梗阻患者的临床资料。结果该组96例患者均顺利完成姑息手术,71例(74.0%)患者成功于输尿管镜下置入双J管,25例(26.0%)患者双J管置入失败,转为经皮肾穿刺造瘘术。32例急性肾衰竭患者术前肌酐平均为(532.3±287.5)μmol/L,术后稳定后肌酐平均水平为(109.4±24.3)μmol/L,差异有统计学意义(P<0.05)。随访68例,目前仍存活31例(45.6%)。71例第1次顺利置入双J管患者中,19例(26.8%)在后期随访治疗过程中因为反复堵管或双J管更换失败,转为肾穿刺造瘘术。19例患者从第1次置入双J管至转为行肾穿刺造瘘术平均时间为(12.3±7.5)个月。结论妇科恶性肿瘤致输尿管梗阻患者整体预后较差,治疗上应选择既能最大限度保证引流通畅,又能兼顾患者生活质量的方法,尽量减少带管及换管过程中给患者带来的不适,首选姑息手术方式为逆行输尿管双J管置入。

Clinical analysis of 96 cases of ureteral obstruction caused by gynecologic malignant tumor

Objective To investigate the efficacy on palliative surgical treatment of ureteral obstruction caused by gynecologic malignant tumor.Methods A retrospective analysis of the clinical data of 96 patients with ureteral obstruction caused by palliative operation.Results The palliative operation was successfully completed in 96 cases,71 cases(74.0%)successfully double-J stenting by retrograde ureteroscopy,but 25 cases(26.0%)failed to retrograde ureteroscopy and converted to percutaneous nephrostomy.The average serum creatinine of the 32 patients with acute renal failure was(532.3±287.5)μmol/L,and the average level of the post-operation was(109.4±24.3)μmol/L,and the difference was statistically different.Of the 68 follow-up cases,31 patients(45.6%)are still alive.19 of the 71 patients(26.8%)who had successful stenting presented with stent failure during the follow-up treatment.The average time from the first stenting to percutaneous nephrostomy was(12.3±7.5)months in 19 patients.Conclusion The overall prognosis of the patients with ureteral obstruction caused by gynecological malignant tumor is poor.In the treatment,we should choose the method which can not only guarantee the urinary tract patency but also take into account the patient’s quality of life.The first choice of palliative operation was retrograde ureteral double-J stenting.