肿瘤治疗后腹膜后纤维化致上尿路梗阻的腔内治疗

目的:总结应用腔内泌尿外科技术治疗继发性腹膜后纤维化致上尿路梗阻的疗效和主要并发症.方法:收集本院2002年1月至2006年6月的27例恶性肿瘤经治疗后发现腹膜后纤维化导致上尿路梗阻的患者,分别接受了经尿道逆行输尿管插管、输尿管狭窄内切开和/或扩张及经皮肾造瘘治疗,总结其疗效和主要并发症.结果:19例单纯输尿管内插入内支架管并定期更换,肾功能改善并基本保持稳定.5例采用顺行或逆行的输尿管镜内切开和/或扩张治疗,并长期停留双J管,4例肾功能有所恢复并稳定,1例效果不理想,改行肾造瘘.3例试行窥镜处理失败,改行长期肾造瘘,肾功能保持稳定.结论:肿瘤治疗后继发性腹膜后纤维化导致的输尿管梗阻,采用腔内技术治疗,能以较小的创伤解除尿路梗阻,是值得推荐的治疗方法.

Endourology Techniques for Treatment of Upper Urinary Obstruction Due to Retroperitoneal Fibrosis Post-treatment of Tumor

Objective:To summarize the efficacy and major complications of endourology techniques in treatment of upper uriary obstruction caused by secondary retroperitoneal fibrosis.Methods: From February 2002 to June 2006,27 patients with upper urinary obstruction due to retroperitoneal fibrosis post-treatment of tumor,under went procedures including retrograde ureteral catheterization,intraluminal ureterotomy and/or balloon dilation,and percutaneous nephrostomy.The efficacy and major complications were summarized.Results:All of 19 patients who received simple insertion and regular change of ureter stents experienced consistent improved renal function.Of 5 patients treated with antegrache or retrograde endoscopic ureterotomy/dilation and long-term indwelling of DJ stent,4 showed recovered and stable renal function,and 1 changed to nephrostomy because of unsatisfying outcomes.Three patients received permenant nephrostomy after unsuccessful endoscopic attempts and remained functionally uneventful.Conclusions: The endourology technique can be a minimally invasive modality in treatment of upper uriary obstruction because of retroperitoneal fibrosis post-treatment of tumor.