经皮下肾盂膀胱分流术的临床应用价值

目的 前瞻性评估经皮下肾盂膀胱分流术对改善经皮肾造瘘术患者生活质量的应用价值.方法 选取16例患者接受23侧经皮下肾盂膀胱分流术.输尿管替代品选取巴德公司分流套件,从肾盂经皮下隧道走行进入膀胱.所有患者每3个月随访1次,共15个月或直至死亡.生活质量评价使用癌症患者生活质量测量表（EORTC QLQ-C30）,并采用超声或静脉尿路造影来观察套件的位置及是否通畅.结果 所有病例均未发生手术失败或急性并发症.平均随访7.3个月,12例患者在平均6.1个月时死于原发肿瘤,4例患者在研究结束时仍存活.所有病例术后生活质量和满意度得到了改善.结论 相比经皮肾造瘘术,经皮下肾盂膀胱分流术显著提高了输尿管梗阻的晚期肿瘤患者的生活质量.

Clinical value of the subcutaneous pyeiovesical bypass

Objective To improve the quality of life of patients with palliative definitive PCN,the subcutaneous ureteral bypass was prospectively evaluated. Methods A series of 16 patients receiving 23 suits in replacement for PCN were evaluated. The detour suits were chosen from Bard company as ureter prosthesis, which were inserted percutaneously into the renal pelvis, tunneled subcutaneously, and introduced into the bladder through a small incision. All patients were followed every 3 months for 15 months or until death from tumor. Quality of life was assessed using the EORTC QLC -30 questionnaire ;ultrasonography, intravenous urography, or both were used to assess the position and patency of the tubes. Results There was no failure of insertion and no immediate complication. The mean followup was 7.3 months,6.1 months for the 12 patients who died from their tumors and 1 year for the 4 patients still alive at the end of the study. Patient ratings of the global quality of life and satisfaction with the urinary diversion were improved. Conclusion The subcutaneous pyelovesieal bypass provides a better quality of life than a standard PCN in terminally ill patients by making them external - tube free.