腹部肿瘤继发输尿管梗阻的微创治疗

目的探讨腹部原发性或转移性肿瘤及其手术、放疗等引起的输尿管梗阻腔内微创治疗方法及疗效。方法 2009年1月至2013年4月南京中医药大学附属中西医结合医院共收治因腹部肿瘤导致的输尿管梗阻患者36例,其中双侧11例,单侧25例,26例行膀胱镜下双J管置入术,7例行经皮肾穿刺微造瘘术,3例行肾盂-膀胱旁路内引流术。结果平均随访8(5²2)个月,术后肾功能显著改善,1周后复查血清肌酐恢复或接近正常,腰腹部不适症状完全缓解,尿量明显增加,3个月复查泌尿系CT或彩色超声,23例肾积水消失,10例肾积水明显缓解,3例肾积水无进展。1例肾造瘘管脱落,予以重新穿刺置管。1例输尿管内双J管下移脱落,予以膀胱镜下重新置管成功,5例双J管引流失败,行经皮肾穿刺微造瘘术。结论腹部肿瘤及其手术、放疗等引起的输尿管梗阻,应根据患者具体情况,选择简单实用的微创治疗方法,可有效引流肾积水,保护肾功能,改善患者生活质量。

Endoscopic mini-invasive treatment of ureteral obstruction related with abdominal tumors

Objective To investigate the method and efficacy of mini-invasive treatment of ureteral obstruction caused by primary or metastatic abdominal tumors and radiotherapy. Methods From January 2009 to April 2013, 36 cases of ureteral obstruction were treated by min-invasive method. D-J stents were successfully placed under cystoscope in 26 cases.Seven cases were treated by mini-pereutaneous nephrolithotomy（Mini-PCNL） after stents placement failed by cystoscope.Three cases were treated by subcutaneous nephro-vesical bypass. Results All patients were followed up for 5 to 22 months（average 8）. Urinary volume increased significantly, and renal function improved excellently with creatinine recovered in 7 days. Hydronephrosis disappeared in 23 cases and relieved in 10 eases. Five cases were relapsed after D-J stents placement and converted to Mini-PCN. Conclusion Endoscopic treatment is mini-invasive and effective. It can improve the renal fimction and increase the quality of life for ureteral obstruction related with abdominal neoplasms.