晚期宫颈癌并发双侧输尿管梗阻40例治疗预后分析

  目的   分析晚期宫颈癌并发双侧输尿管梗阻的预后因素, 探讨其治疗意义。   方法   通过肾图、CT、肾功能检查诊断晚期宫颈癌并发双侧输尿管梗阻患者40例, 膀胱镜下输尿管逆行置管内引流13例, 经皮肾穿刺输尿管顺行置管内引流25例、外引流2例, 肾功能恢复正常后行放射治疗29例, 对比研究输尿管导管置入前是否接受过治疗、肾功能是否正常, 置管后是否接受放疗三种因素对预后的影响。   结果   输尿管导管置入后肾功能恢复正常率为91.3% (21/23)。未治疗组、术后和放疗后复发组中位生存时间分别为27、15、10个月(χ2=9.379, P=0.009)。置管后接受放疗组与未行放疗组中位生存时间分别为25、9个月(χ2=17.329, P < 0.001), 置管前肾功能是否正常对预后影响无显著性差异(χ2=1.37, P=0.242)。   结论   对于初治或术后复发的宫颈癌并发双侧输尿管梗阻患者, 在解除输尿管梗阻后, 应接受放射治疗, 可获得较好疗效。      

放疗后双侧输尿管梗阻的腔内泌尿外科处理

背景与目的：在盆腹腔肿瘤放疗后出现输尿管梗阻、肾功能不全的患者,临床上经膀胱镜放置输尿管内支架引流困难。肾造瘘外引流常常是处理这种患者的惟一办法。但肾造瘘外引流往往影响患者的生活质量。我们拟利用微穿刺肾造瘘与输尿管镜技术放置输尿管双猪尾导管内引流治疗放疗后双侧输尿管梗阻患者,以探讨其腔内泌尿外科处理的可行方法。方法：对19例盆腹腔肿瘤放疗后出现双侧输尿管梗阻、肾功能不全的患者,利用微穿刺肾造瘘与输尿管镜技术放置输尿管支架内引流。观察内支架引流情况与肾功能改善的情况。结果：2例经输尿管镜逆行放置两侧输尿管双猪尾导管内引流,17例经皮肾穿刺造瘘和扩张后于单侧输尿管放置两根不同直径的双猪尾导管内引流。随访1～24个月,17例引流通畅,肾功能恢复正常,血肌酐为45～113μmol／L,另2例肾功能无改善,改行经皮肾穿刺造瘘外引流。结论：经皮肾穿刺造瘘在单侧输尿管内放置两根双猪尾导管内引流,处理放疗后双侧输尿管梗阻、肾功能不全,结果有效、手术操作方便、安全。     

晚期肿瘤致输尿管梗阻支架置入困难的微创处理

目的:对微创手术技术处理恶性肿瘤致输尿管梗阻输尿管支架置入困难病人,探讨其手术方法、技巧等临床处理经验。方法:回顾性分析14例（19侧）恶性肿瘤继发输尿管梗阻输尿管支架置入困难的病人分别通过逆行输尿管扩张置管术、经皮肾穿刺顺行斑马导丝引导下置管术、微创经皮肾造瘘术解除梗阻,分析临床处理过程及治疗效果。结果:所有14例患者通过三种手术方式成功解除梗阻,随访所有患者肾功能在术后短期内恢复正常水平并顺利完成后续治疗,手术过程顺利,无重大并发症发生。结论:微创逆行输尿管扩张置管术、经皮肾穿刺顺行斑马导丝引导置管术和经皮肾穿刺造瘘术可以解决晚期肿瘤肾后性梗阻置管困难问题,是安全有效的手术方式。     

Incidence and management of major urinary complications after pelvic exenteration for gynecological malignancies

Urinary fistulae and obstruction following pelvic exenteration are frequent and life-threatening complications. They increase the mortality and morbidity rates of large exereses performed during pelvic exenteration for gynecological cancers. From a series of 97 patients who underwent pelvic exenteration for gynecological cancers we report the incidence, risk factors, and management of major urinary complications. Eighty patients had had previous surgery and/or pelvic radiation therapy at the time of pelvic exenteration. A urinary diversion was performed in 63 patients. Major early urinary complications were: urinary fistula in seven patients and ureteral obstruction in four patients (11.3% of the patients). Ten patients had a late urinary complication: stenosis of the cutaneous ureteral meatus (five), stenosis of the ureteroileal anastomosis following ileal loop (two), and urinary fistulae (three). Cancer recurrence was found in 4 of these 10 cases. Major early urinary complications were significantly increased in patients who had received previous pelvic radiation therapy (P < 0.05) and in patients who had had an intestinal conduit for urinary diversion (P < 0.05). Reoperation was done in six of seven cases of early urinary fistula (urinary undiversion four, nephrectomy one, ureteral reimplantation one). Three of four ureteral obstructions were managed with percutaneous nephrostomy and ureteral stent. We recommend the use of nonirradiated bowel segment for urinary diversion as transverse colon or jejunal conduit in patients who have received previous high doses of pelvic radiotherapy. For the management of urinary complications post pelvic exenteration, reoperation is required for most urinary fistula but ureteral obstructions can be managed with percutaneous nephrostomy and ureteral stent. © 1995 Wiley-Liss, Inc.     

恶性肿瘤继发双侧输尿管梗阻的腔内治疗

目的分析腔内泌尿外科技术治疗恶性肿瘤继发双侧输尿管梗阻。方法回顾性分析43例(70例次)恶性肿瘤继发双侧输尿管梗阻患者应用腔内技术治疗的疗效。在治疗的70例次中,应用逆行输尿管镜置管术38例次,微创经皮肾穿刺造瘘术(MPCN)24例次,顺行输尿管镜置管术8例次。结果43例患者术后平均随访12个月。逆行输尿管镜置管术、MPCN术和顺行输尿管镜置管术的治疗成功率分别为50.0%(19/38)、100.0%(24/24)和62.5%(5/8)。肿瘤侵袭输尿管开口(13/38)和严重腔外梗阻(6/38)是导致逆行输尿管镜置管术失败的主要原因;严重腔外梗阻(3/8)是导致顺行输尿管镜置管术失败的主要原因;术后肾造瘘管脱出(11/19)是限制MPCN应用的主要因素。结论腔内技术治疗恶性输尿管梗阻是安全、有效的。逆行输尿管镜置管术是本病的首选治疗方法,但对于肿瘤侵袭输尿管开口或严重腔外梗阻患者,可根据梗阻的部位和程度选用MPCN术或顺行输尿管镜置管术。     

Obstructive renal failure in patients with terminal malignant tumors--unilateral relief of ureteral obstruction and recovery of renal function on the opposite side

In obstructive renal failure in patients with terminal malignant tumors, we relieved the obstruction on only one side. As a result, it was found that the renal function of the other side also recovered (in five out of 19 patients 26.3%). Therefore, obstructive renal failure in these patients was caused not only by direct obstruction by the tumor, but also by renorenal reflex, humoral factors such as uremic toxius and edema of tissues around the ureter. It would be correct to assume that a reversible mechanism, such as ureteral stent insertion, percutaneous nephrostomy, etc. Should first be selected, rather than permanent urinary diversion.     

Urologic emergencies in the cancer patient

Urologic emergencies are common in the cancer patient and relate mainly to complications of bladder hemorrhage, upper or lower urinary tract obstruction, urinary tract infection, and priapism. Hemorrhagic cystitis is commonly due to bladder injury from radiation therapy, viral infection, or metabolites of chemotherapeutic agents. Treatments aimed at ameliorating the effects of theses metabolites, such as mesna and intravenous (IV) hydration, coupled with cystoscopy, evacuation of clots, and formalin instillation, have given clinicians an effective means of avoiding exsanguinating hemorrhage from the bladder. Malignant ureteral obstruction is an ominous sign in the cancer patient and may be due to tumor compression, retroperitoneal adenopathy, or direct tumor invasion. The endourologic procedures of ureteral stenting and percutaneous nephrostomy are effective means of palliation; however, complications of infection, stent obstruction, and stent migration can result in hospital admission and a decline in quality of life. Median survival for patients with malignant ureteral obstruction is less than 7 months, regardless of the tumor of origin. Bladder outlet obstruction leading to urinary retention can be due to mechanical factors involving the bladder neck or prostate, or to a breakdown in the neurophysiologic function of the bladder. Every attempt is made to avoid surgical intervention or the placement of chronic in-dwelling catheter in these often debilitated patients. Patients are often effectively treated with a variety of pharmacologic agents, such as alpha-adrenergic receptor blockers or by the initiation of chronic intermittent catheterization. Urinary tract infections are particularly dangerous in neutropenic and bone marrow transplant patients, with bladder catheters the most common portal entry. The colonization and later infection by resistant nosocomial organisms, such as Pseudomonas aeruginosa and Candida albicans, can rapidly lead to life-threatening sepsis. On rare occasions, emergency surgical intervention with adequate open drainage or nephrectomy is required to control such infections. Priapism can be caused by hematologic malignancy with hypercoagulation, metastatic disease involving the corpora cavernosa with thrombosis of the venous outflow from the penis, or rarely from intracavernous injections used for the treatment of impotence. If effective treatment exists for the primary tumor, improvement or resolution of the state of priapism may occur. Radiation therapy may be required to decrease the pain associated with malignant priapism, but surgical shunting procedures are rarely effective.     

Role of interventional radiography in the treatment of the hepato-pancreato-duodenal area,complicated by obstructive jaundice

We assessed the role of interventional radiological procedures used in the treatment of patients with hepatopancreatobiliary cancer complicated by obstructive jaundice. Between 1990 and 2000, 71 patients underwent percutaneous transhepatic biliary drainage (PTBD): external drainage--18 (group A); external-internal drainage or stenting (group B), and external-internal drainage or stenting plus chemoinfusion or chemoembolization of the hepatic artery--15 (group C). Mean survival (M(SD) calculated for patients who died was 2.1(0.5 mo for group A; (pb,c(0.01), 7.9(6.7 mo (group B), and 16.6(14.8 mo for group C (NS with B). The actual one-year survival was 10, 25, and 45%, respectively. External-internal PTBD and stenting are safe effective palliative procedures for patients with malignant obstructive jaundice. Survival in patients with hepatopancreatobiliary cancer doubled after chemoinfusion or chemoembolization, without grave complications or lethality.     

Gastric cancer recognized by metastasis to the ureter

Although ureteral obstruction is rarely noted in patients with gastric cancer at an advanced stage or at autopsy, the condition caused by authentic ureteral metastasis of gastric cancer is extremely rare. We experienced a case of gastric cancer in a 51-year-old woman who showed bilateral ureteral metastasis. The patient initially complained of right flank pain, caused by right ureteral obstruction, and was referred to our hospital, where she underwent a right nephroureterectomy, with suspicion of primary ureteral neoplasm. Histopathological examination of the resected specimen showed that metastatic growth of adenocarcinoma in the ureteral wall had caused the obstruction, and the subsequent extensive search for the primary lesion revealed asymptomatic gastric cancer. Soon after the nephroureterectomy, the patient developed left hydronephrosis, possibly caused by left ureteral metastasis, and a left percutaneous nephrostomy was performed. She then received chemotherapeutic reagents. However, she finally developed peritoneal carcinomatosis, and died of the disease about 1 year after the onset of the disease. In this report, we also review true ureteral metastasis from the stomach, and discuss the clinicopathologic features. Received: March 28, 2000 / Accepted: May 19, 2000     

经皮肾造瘘治疗恶性输尿管梗阻预后因素分析

[目的]探讨经皮穿刺肾造瘘治疗恶性输尿管梗阻的预后因素。[方法]经皮穿刺肾造瘘治疗恶性输尿管梗阻61例,选择性别、年龄、KPS评分、原发肿瘤部位、输尿管梗阻程度、术前血肌酐和尿素氮水平、引流方式、经皮肾造瘘穿刺术后是否结合经导管动脉灌注化疗以及生存时间等因素作为研究对象,应用Kaplan-Meier和Cox模型进行单因素与多因素生存分析。[结果]术后随访3￣36个月,平均生存期为9.7个月,1年生存率29.1%。单因素分析显示,KPS评分、梗阻程度、术前肾功能水平以及与是否结合动脉灌注化疗对预后有显著影响,多因素分析表明是否结合动脉灌注化疗是影响预后的主要因素。[结论]恶性输尿管梗阻经皮肾造瘘治疗后结合动脉灌注化疗是影响其预后的最主要因素,联合治疗有可能提高生存率。     

盆腔恶性肿瘤术后输尿管下段梗阻的腔镜手术治疗

背景与目的:盆腔恶性肿瘤手术后组织粘连、瘢痕形成或放射治疗等常导致输尿管下段受压梗阻及肾积水.本研究旨在评价利用腔镜技术治疗此类输尿管梗阻的疗效与安全性.方法:1998年1月至2007年3月,46例有输尿管下段梗阻伴盆腔肿瘤史的患者在中山大学附属第三医院接受了腔镜手术,分析嗣手术期及随访资料.结果:46例患者中,25例行腹腔镜输尿管-膀胱吻合术,18例行输尿管镜放置支架管引流,3例行经皮肾造瘘术,未发生严重并发症.平均手术时间82.5 min(30～140 min),术中出血45.5 ml(5～180 m1),均未接受输血.中位随访时问18.2个月(3个月～6.5年).术后3个月,静脉尿路造影及B超提示39例(84.8%)肾分泌恢复正常,其余7例(15.2%)肾积水减轻、肾功能改善;核素扫描提示平均患侧肾小球滤过率比术前升高(37.6 ml/min vs.21.3 ml/min,P＜0.05).所有输尿管-膀胱吻合口无狭窄.结论:腔镜手术治疗部分类型盆腔肿瘤手术后或放疗后下段输尿管梗阻是有效、可行的.     

Laparoscopic and renal sparing approaches to tumours of the ureter and kidney

Until recently, malignancies of the kidney and ureter were managed with open radical surgery. Over the last decade the urologic community has adopted the skill of laparoscopic surgery for the treatment of these tumours. Parenchymal sparing procedures have become the standard of care in the treatment of selected patients with renal and ureteral tumours and many of these surgical procedures can be performed laparoscopically or ureteroscopically. Due partly to necessity and partly to the advancement of technology, renal and ureteral sparing procedures have become commonplace for definitive treatment and palliation of these tumours. The morbidity of such procedures is significantly less than for open surgery and the future of urologic minimally invasive surgery appears secure. This review article is aimed at updating the reader in the most recent advances in these techniques.     

Manifestation,latency and management of late urological complications after curative radiotherapy for cervical carcinoma

BACKGROUND: Radiotherapy alone or in combination with radical hysterectomy remains a potentially curative treatment for cervical carcinoma. Late urological complications after curative radiotreatment are rare but often present difficult problems of management due to the progressive nature of radiogenic tissue damage. We reviewed all cases of radiogenic urologic complications after radiotherapy for cervical carcinoma treated at our institution over the past 10 years. PATIENTS AND METHODS: In a retrospective analysis, out of all female patients treated for hydronephrosis (n = 543), 93 patients with hydronephrosis occurring after curative treatment for gynecological malignancies were identified. The most frequent cause was progressive disease (n = 55); 30 patients without recurrence had severe radiogenic urological complications (study population). RESULTS: Out of 30 patients with a mean age of 44.9 years at the time of treatment for cervical cancer, 6 had undergone primary radiotherapy and 24 had received adjuvant radiotreatment after radical hysterectomy. The observed late urological complications were: distal ureteral stenoses (bilateral in 4 cases, unilateral in 15 cases), distal ureteral necrosis (n = 1), bilateral ureteral reflux (n = 3), vesico-vaginal fistulae (n = 5), vesico-intestinal fistula (n = 1), severe fibrotic bladder shrinkage (n = 6) and urethral stenosis (n = 2). Marked signs of radiogenic cystitis were observed in almost all patients. The mean latency time between radiotherapy and manifestation of severe radiogenic urological sequelae was 19.4 years (range 0.5-41.5). Primary treatment of urological complications consisted in temporary urinary diversion by percutaneous nephrostomies or insertion of internal ureteral stents. Permanent treatment for radiogenic ureteral stenosis in all patients with sufficient general health consisted of surgical or endourological urinary diversion or reconstruction. However, the majority of patients were managed by permanent endourological measures. Lower tract fistulae were treated by distal ureteral occlusion and diversion. CONCLUSIONS: Although severe late urological sequelae of curative radiotherapy for cervical carcinoma are rare they represent major complications, result in considerable distress for the patient, and often present difficult therapeutic problems for the urologist. As these urological complications can have extremely long latency times, focussed follow-up for early detection may be advisable.     

Two methodologies of the rendezvous procedure to establish ureteral continuity from a delayed ureteral leak following pelvic surgery

BackgroundUreteral trauma recognized in the operating theater is managed, for the most part, at the same surgical procedure oftentimes with urologic consultation. A delayed urine leak presents unique problems in that direct access to the site of the leak is not possible except by a reoperative procedure.MethodsIn patients who develop delayed urine leakage following cancer surgery, the leakage may be controlled by the collaborative efforts of a urologist and interventional radiologist. Success depends on placement of a nephroureteral stent by the rendezvous procedure.ResultsThe sequence of procedures to reestablish ureteral continuity following a delayed leak are important in the successful placement of a nephroureteral stent. In the first methodology, through a percutaneous nephrostomy, a guidewire is placed in the ureter and down to the ureteral defect. The guidewire is then recovered and advanced into the bladder using a ureteroscope and grasping forceps. A nephroureteral stent is placed over the guidewire to bridge the gap and stent the ureteral defect. In the second methodology, the urologist passed a guidewire into the distal ureter, out of the ureteral defect, and into the free peritoneal space. Under fluoroscopic control, the wire loop must snare the ureteral guidewire and pull it out at the percutaneous nephrostomy. The nephroureteral stent is passed over the ureteral wire into the bladder.ConclusionsTwo different methodologies were described to complete the rendezvous procedure. It can be successful a large percentage of the time with a delayed ureteral leakage. Success requires a combined interventional radiology and urologic procedure.     

Use of ureteral stents in patients with kidney transplantation

The aim of the study was to determine indications for application of ureteral stents for draining urinary tracts of the renal transplant, after low-invasive surgical interventions, for timing drainage, prevention and correction of complications. Ureteral stent insertion for management of urological complications after transplantation of the kidney was made in 36 patients (25 of them have ureteral stricture, 11 had ureteral necrosis). Low-invasive operations were made in 28 patients, open reconstructive plastic operations were conducted in 12 patients. According to 6-12 follow-up of the stented patients, recurrent ureteral stricture was detected only in 4 patients (11.1%). The stricture was corrected transcutaneously by antegrade ureteral stenting. It is concluded that stenting of the urinary tracts of the transplanted kidney in the treatment of urological complications--necrosis and ureteral stricture--in the course of low-invasive roentgenoendoscopic and open reconstructive-plastic operations raises treatment efficacy and prevents recurrent stricture.     

Feasability of retroperitoneal pelvic lymph node exploration in cervical carcinoma. Assessment of morbidity in 33 cases treated by combined radio-surgery or definitive radiotherapy

Background and purposes: Laparoscopic modalities by selective biopsies permit a better assessment of the pelvic lymph nodes status than imaging procedures in cervix carcinoma. They could enable the radiation oncologist to adapt the target volume of external irradiation, provided the feasibility of such procedures is good and the toxicity reduced as much as possible.

Material and methods: From June 1980 to May 1993, 52 women with a mean age of 49, underwent a retroperitoneal pelvic lymph node laparoscopic procedure for cervix carcinoma classified according to FIGO as stages IA₂ (14), IB (12), IIA (6), IIB (14), IIIB (3) and IVA (3). Two techniques were used: retroperitoneoscopy (RPS) in 16 cases, and a panoramic retroperitoneal pelviscopy (PRPP) in 36 cases.

Results: Intra-operative and post-surgical morbidity were equivalent in the two procedures. Among the 33 patients who had external irradiation, one Grade 3 urinary late morbidity (3%) due to an overtreatment was observed; no Grade 3/4 morbidity of the gastro-intestinal tract, no lymphoedema of the lower extremities, no parietal tumor cells implantation were noticed.

Conclusions: These procedures can be used safely to better know the prognosis and to define the pelvic lymph node planning target volume and its radiation management with accuracy.     

Radiological management of patients with urinary obstruction following urinary diversion procedures: technical factors, complications, long-term management and outcome. Experience with 378 procedures

We aimed to assess management by interventional radiology techniques of patients with urinary diversion procedures (UD) complicated by urinary obstruction (UO). A 12-year electronic database of interventional cases was searched for urinary access in patients with UD. Patients' records were assessed for aetiology of obstruction, indication for procedure, types of interventional radiology, complications and outcome. Management issues included frequency of visits for catheter care, type of catheter placement and technical problems associated with catheter maintenance. Three hundred and seventy eight procedures were carried out in 25 patients (mean age 70 years; Male : Female ratio 13:12). Indications for UD were malignancy (n = 22) and neuropathic bladder (n = 3). UD included ileal conduits (n = 17), cutaneous ureterostomy (n = 3 (2 patients)) and sigmoid colon urinary conduit (n = 6). In most patients, catheters were placed antegradely through nephrostomy tract, but subsequent access was through the UD. Twenty of 25 patients had unilateral stents where as 5 had bilateral stents (8-10- Fr pigtail catheters (20-45 cm in length)). The mean number of procedures including catheter changes was 15 +/- 4 per patient and 331 of 378 procedures (87 %) were carried out as outpatients. Since catheter placement, 11 patients required hospital admission on 22 occasions for catheter-related complications. Ureteric strictures in patients with UD can be successfully managed by interventional radiology.     

Factors Affecting Survival Outcome After Percutaneous Nephrostomy as Palliative Urinary Diversion in Obstructive Uropathy due to Advance Cervical Cancer Patients

Introduction: Cervical cancer is the 3rd most common cancer in women. In late stages, obstructive uropathy due to mass infiltration is common and the mainstay of treatment for this condition is palliative urinary diversion through percutaneous nephrostomy. Nevertheless, complications due to nephrostomy may have adverse effects on some patients. Further study is necessary to determine whether nephrostomy is suitable for all cervical cancer patients with obstructive uropathy. This study aims to identify the determinants of survival rate of cervical cancer patients undergoing nephrostomy for obstructive uropathy and determine the group of cervical cancer patients that would benefit the most from nephrostomy. Methods: Data were obtained from medical records of cervical cancer patients in Hasan Sadikin Central Public Hospital from January 2018 to December 2019. Log-rank analysis was performed to assess the survival rate of patients based on clinical conditions (age, metastasis, and ECOG performance status) and initial laboratory results (hemoglobin, leukocyte, thrombocyte and blood acidity). Results: A total of 163 cases were identified from the medical records, with a median survival of 5(1-17) months. The results of the analysis showed that the survival rates of cervical cancer patients undergoing nephrostomy were significantly affected by age (p = 0.0001), metastasis (p = 0.0001), and ECOG performance status (p = 0.0001), while laboratory findings were not significant factors affecting survival (pHb=0.501; pLeu=0.634; pTr=0.077; pBGA=0.687). Conclusion: The survival after nephrostomy in advanced cervical cancer patients is largely affected by age, metastasis, and performance status. The choices of doing nephrostomy in those patients should be considering those factors to maximize the benefit over the risk of complications.     

Urologische Aspekte in der Palliativmedizin

Several abdominal and pelvic tumors cause external compression of the ureters. Hydronephrosis resulting in renal insufficiency is the most common urological complication in the palliative situation. Although it is always possible to insert a ureteral catheter or, if this is not successful, to perform a nephrostomy, the indications for this in a palliative setting should be strongly considered. This is also true for the indications for definitive supravesical urinary diversion. Other tumor or therapeutically caused complications are macrohematuria and urinary fistula. Besides urological aspects within palliative care in general, the treatment of nearly all advanced urological tumors is of palliative character. Most important are sufficient pain medication and supportive care for complications such as supra- or infravesical urinary obstruction, incontinence, hematuria, urinary fistula, fractures and exulceration of the tumor. In patients with a supravesical urinary diversion, special aspects of the diversion have to be taken into account, e.g. metabolic acidosis.     

超声引导下经皮肾穿刺造瘘术治疗晚期结直肠癌致梗阻性肾积水的疗效观察

目的探讨超声引导下经皮肾穿刺造瘘术治疗晚期结直肠癌致梗阻性肾积水的临床效果及对肾功能的作用。方法选取2016年8月至2019年6月间泉州市第一医院收治的72例晚期结直肠癌致梗阻性肾积水患者,采用随机数字表法分为观察组和对照组,每组36例。对照组患者采用传统经皮肾穿刺造瘘术,观察组患者采用超声引导下经皮肾穿刺造瘘术,比较两组患者的临床疗效与肾功能变化。结果所有患者均一次穿刺成功,观察组患者手术时间、术中出血量、术后造瘘管拔除时间和术后住院时间均短于对照组,差异均有统计学意义(均P<0.05)。术后1个月,观察组患者出血、感染、堵管和脱管等情况发生率为5.6%,低于对照组的30.6%,差异有统计学意义(P<0.05)。术后1个月,两组患者血清肌酐和尿素氮值均较术前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。术后随访1年,观察组患者复发率为2.8%(1例),低于对照组的19.4%(7例),差异有统计学意义(P<0.05)。结论超声引导下经皮肾穿刺造瘘术治疗晚期结直肠癌致梗阻性肾积水患者,能降低患者并发症和复发率,改善肾功能,促进术后康复。