经皮下置管输尿管旁路肾膀胱分流术在输尿管梗阻中的临床应用

目的:探讨经皮下置管输尿管旁路肾膀胱分流术(EAS)在治疗因晚期腹腔、盆腔及腹膜后恶性肿瘤所导致的输尿管梗阻中的临床应用价值及预后效果。方法:回顾性分析14例15侧EAS患者的临床资料及随访情况。结果:14例手术分流置管均成功,未出现任何并发症,术后72小时KUB及B超均显示导管位置良好;15侧肾积水明显减轻或消失,术后血肌酐水平较术前明显降低。其中1例术后1周内出现严重泌尿系感染,高烧寒战,应用抗生素效果不好,取出皮下旁路置管,改为经皮肾造瘘,病情得到控制。其余13例术后随访3~13个月,1~3个月疗效满意,仅有一过性镜下和肉眼血尿;置管6~13个月患者中有5例存在一过性肉眼血尿和不同程度的泌尿系统感染,予以更换导管处理,其中3例患者反复出现感染症状,药物治疗未能有效控制,最终改为经皮肾造瘘外引流。本组带管生存最长13个月。结论:EAS是一种尿流改道手段和方法,操作简单、微创,较之传统的经皮肾造瘘术为优,避免了繁琐的生活护理,提高了生活质量,适用于晚期肿瘤引起的输尿管梗阻。

Clinical application of subcutaneous ureteral bypass in ureteral obstruction

Objective：To evaluate clinical value and prognosis of subcutaneous ureteral bypass in ureteral obstruction caused by abdominal, pelvic and retroperitonea[ malignant tumor at an advanced stage. Method：The data of 15 sides in 14 cases including surgical records and follow-up results were analyzed retrospectively. Result：Fourteen cases of surgical shunts were successful without complications. At postoperative 72 hours KUB and ultrasound showed that the catheters were leaded to desirable locations. Hydronephrosis of fifteen sides significantly reduced or disappeared, and postoperative serum creatinine levels decreased obviously compared with peroperative results. However, one patient suffered from severe urinary tract infection, high fever and chills a week later and was not sensitive to antibiotics. Then subcutaneous bypass was replaced by percutaneous nephrostomy and it provided effective symptom control. The rest 13 cases were followed up for 3-13 months. The results were as follows： first 1-3 months the curative effect was satisfied except for a transient microscopic and gross hematuria; subsequent 6-13 months five patients experienced macroscopic haematuria and urinary system infection; three of them suffered from recurrent symptoms of infection; drug treatment has failed and percutaneous nephrostomy drainage was inevitable. The maximum survival was 13 months. Conclusion： Subcutaneous ureteral bypass is a kind of easy-to-operate, minimal invasive urinary diversion and is superior to percutaneous nephrostomy. This surgical method is suitable for ureteral obstruction caused by advanced cancer since it avoids the tedious life care and improves the quality of life.