恶性输尿管梗阻的腔内微创治疗(附85例报告)

目的探讨盆腔肿瘤或盆腔转移性肿瘤及放疗等引起的恶性输尿管梗阻的腔内微创治疗方法和效果。方法2004年1月-2007年1月收治恶性输尿管梗阻病人85例,采用腔内泌尿外科微创治疗,其中72例经尿道膀胱镜下（25例）或输尿管镜下（47例）留置双J管,单侧42例,双侧30例,13例经皮肾穿刺微造瘘顺行放置2根双J管。结果所有病例均获随访,平均9（6-24）个月。术后下腹不适15例,排尿时腰部胀痛22例,肉眼血尿3例,均自行缓解。腹平片未发现双J管移位。术后3个月更换双J管时,未发现导管周围结石形成。71例患者留置双J管后引流通畅,尿量明显增加,肾功能复查,肌酐5-7 d恢复正常或接近正常,B超示置管侧肾积水减轻。14例患者术后B超示肾积水无明显改变,肾功能改善不明显,改行经皮肾穿刺微造瘘术后肾功能恢复正常。8例术后9-15月再发梗阻,经皮肾穿刺微造瘘术后肾功能恢复正常。结论恶性输尿管梗阻的腔内治疗创伤小,疗效确切,可以为患者解除痛苦,提高生活质量。

Endoscopic Mini-invasive Treatment of Malignant Ureteral Obstruction(A Report of 85 Cases)

Objective To explore the method and effect of endoscopic mini-invasive treatment of malignant ureteral obstruction caused by pelvic tumor, pelvic metastatic tumor and radiotherapy. Methods From Januarary 2004 to Januarary 2007, 85 cases of malignant ureteral obstruction were treated by endoscopic miniinvasive method. 72 cases were detained pigtail stents under cystoscope （25 cases） or ureteroscope （47 cases）, including 42 cases of unilateral pigtail and 30 cases of bilateral. The other 13 cases were placed 2 pigtail stents to each one by mini-percutaneous nephrolithotomy （Mini-PCNL） ＇after stents placement failed by urethra approach. Results All patients were followed up for 6 to 24 months （average 9）. There were lower abdominal complaint in 15 cases, urinate distending pain in 22 and gross hematuria in 3, and all were self relieved. The plain film showed no shifting of pigtail stents. No lithogenesis was observed around the pigtail stent when the pigtail was changed 3 months later. 71 cases were drained smoothly, urinary volume increased significantly, renal function improved with creatinine recovered in 5 to 7 days and nephrohydrops relieved. Mini-PCNL was adopted in other 14 cases which were not improved, and then their renal function was recovered. 8 cases were relapsed within 9 to 15 months after operation and were achieved renal function recovered by Mini-PCNL. Conclusion Endoscopic treatment is mini-invasive and effective, and it can relieve the suffering and increase the quality of life for malignant ureteral obstruction patients.