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。

An Analysis of Prognostic Factors of Percutaneous Nephrostomy for Patients with Malignant Ureteral Obstruction

[Purpose] To assess prognostic factors of percutaneous nephrostomy(PCN) for malignant ureteral obstruction. [Methods] Sixty-one patients with malignant ureteral obstruction underwent PCN. The gender, age, KPS, primary tumoral site, the obstructive level, preoperative serurm creatinine and blood urea nitrogen levels, drainage way, transcatheter arterial chemo-infusion(TAI), and survival were analyzed. The univariate and multivariate survival analysis were performed with Kaplan-Meier and Cox regression. [Results] The patients were followed-up for 3 to 36 months, with mean survival 9.7 months and 1-year survival rate 29.1%. In univariate analysis the variables associated with survival were KPS index, obstructive level, preoperative serum creatinine and blood urea nitrogen level, whether TAI having been performed. By multivariate analysis, TAI was the independent prognostic factor. [Conclusion] TAI after PCN was an independent prognostic factor in patients with malignant ureteral obstruction. Combination therapy might prolong survival.