晚期前列腺癌侵犯输尿管口的腔内姑息性治疗15例临床分析

目的：探讨晚期前列腺癌侵犯输尿管口导致肾积水行经尿道输尿管口等离子电切术的临床疗效．方法回顾性分析15例晚期前列腺癌侵犯输尿管口导致肾积水患者的临床资料：年龄65～85岁，平均75.5岁；B超：积水肾24个；血浆 BUN 8.9～28.5 mmol/L，平均13.2 mmol/L，血浆Cr 126.7～369.2μmol/L，平均243.3μmol/L．放射性核素肾显像：肾小球滤过率31.1～66.2 mL/min，平均48.6 mL/min，积水肾均存在上尿路梗阻．均采用经尿道输尿管口等离子电切术及最大限度雄激素阻断治疗．结果手术均顺利，手术时间50～100 min，平均为65 min．出血量30～65 mL，平均45 mL．术后4 d拔除导尿管出院．随访2~4周．术后1周复查B超示肾积水改善18个（75%），未有明显变化6个（25%）；术后2周复查B超示肾积水改善20个（83.3%），未有明显变化4个（16.7%）．术后2周复查血浆 BUN 6.6～21.30 mmol/L，平均10.75 mmol/L；血浆 Cr 97.5～286.6μmol/L，平均187.3μmol/L；放射性核素肾显像示肾小球滤过率37.8～79.2 mL/min，平均58.1 mL/min，积水肾上尿路引路均通畅．结论晚期前列腺癌侵犯输尿管口导致肾积水行经尿道输尿管口等离子电切术可短期内有效缓解上尿路梗阻，改善患者肾功能．

Endoluminal Palliative Treatment for Ureteral Orifice Invaded by Advanced Prostate Cancer

Objective To evaluate the clinical efficacy of transurethral resection of ureteral orifice invaded by advanced prostate cancer caused hydronephrosis. Methods A retrospective study was done in 15 patients who were diagnosed by advanced prostate cancer with invasion of ureteral orifice and treated by transurethral resection of ureteral orifice and maximal androgen blockade. 24 kidneys were diagnosed as hydronephrosis by ultrasound. Before the procedure, the average serum BUN was 13.2 mmol/L （8.9~28.5）, the average serum Cr was 243.3 μmol/L （126.7~369.2）, the average GFR evaluated by renal radionuclide imaging was 48.6 mL/min （31.1~66.2）, and the upper urinary tract was obstructed in kidneys with hydronephrosis. Results All 15 patients underwent successfully transurethral resection of ureteral orifice and discharged after 4 days stay. The average procedure time was 65 min （50~100 min） and mean blood loss was 45 mL （30~65 mL） . The patients were followed up for 2~4 weeks. Hydronephrosis examined by ultrasound was ameliorated in 18 kidneys （75%） and not obviously changed in 6 kidneys （25%） in one week after procedure. Hydronephrosis examined by ultrasound was ameliorated in 20 kidneys （83.3%） and not obviously changed in 4 kidneys （16.7%） in two weeks after procedure. Within two weeks after procedure,the average serum BUN was 10.75 mmol/L （6.6~21.30 mmol/L）, the average serum Cr was 187.3μmol/L （97.5~286.6 μmol/L）, the average GFR evaluated by renal radionuclide imaging was 58.1 mL/min＆amp;nbsp;（37.8~79.2 mL/min）,and upper urinary tract was unobstructed. Conclusion Upper urinary tract obstruction and renal function were ameliorated and improved in a short time by transurethral resection of ureteral orifice invaded by advanced prostate cancer which caused hydronephrosis.