T管造瘘在晚期宫颈癌患者输尿管支架置入中的应用

目的：探讨在晚期宫颈癌患者行常规膀胱镜检无法找到输尿管开口时,T管输尿管造瘘在输尿管支架置入中的应用效果.方法：12例晚期宫颈癌合并肾积水患者,行常规膀胱镜检未找到输尿管开口18侧例,通过背部直切口下输尿管T管造瘘、灌注美蓝、X线下斑马导丝探寻、顺行造影等多种方法,引导经尿道输尿管镜找到输尿管开口,逆行进入输尿管并置入支架.结果：17侧例输尿管支架放置成功,1侧例由于下段输尿管完全闭锁予留置T管行体外引流,并于1个月后更换引流管.结论：晚期宫颈癌常规镜检无法找到输尿管开口的患者,仍有很大机会获得内引流成功,外引流并非首选.背直切口下行输尿管T管造瘘创伤小、成功率高,在为外引流做好准备的同时,大幅提高了内引流成功率,提升了患者的生活质量,值得推广.

Application of T-tube fistula in ureteral stenting insertion in patients with advanced cervical cancer

Objective：To evaluate the application value of T-tube fistula in ureteral stenting insertion in patients with advanced cervical cancer under the condition of unclear ureter openings through cystoscopy. Methods：The ureter openings of 18 sides in 12 patients with advanced cervical cancer complicated with hydronephrosis could not be found by cystoscopy. The ureter openings were explored by T-tube fistula under the straight incision of back, perfusing methylene blue, wire search under X-ray and anterograde venography, ureteral stent was retrogradely implanted into ureter. Results：The ureteral stents were successfully implanted in 17 sides. T tube in 1 case with lower ureter atresia was placed for external drainage ,which was replaced after 1 month. Conclusions ：The effects of internal drainage in the patients with advanced cervical cancer complicated with unclear ureter openings through cystoscopy maybe good, external drainage is not preferred. T-tube fistula under the straight incision of back is less trauma and high success rate. Increasing the success rate of internal drainage can improve the life quality of the patient, which is worthy to spread.