Minhas S, Irving H C, Lloyd S N, Eardley I, Browning A J, Joyce A D
Department of Urology, St James University Hospital, Leeds, UK.
BJU Int. 1999 Nov;84(7):762-4. doi: 10.1046/j.1464-410x.1999.00315.x.
To assess the role of extra-anatomic stents (EAS) as a means of urinary diversion in patients with ureteric obstruction secondary to malignancy.
The technique for inserting EAS in patients with ureteric obstruction was described previously; to date, 13 patients (seven women and six men, mean age 45.3 years, range 22-78) have been treated. All patients had ultrasonographic evidence of hydronephrosis and/or significant biochemical evidence of renal impairment. Patients had advanced malignancy and one patient an abdominal aortic aneurysm.
Urinary diversion was successful in all patients; two survived for more than 1 year, with stent changes at 6-monthly intervals. In three patients the stents were replaced by percutaneous nephrostomies because of problems with leakage or infection. The remaining patients died with functioning EAS in situ.
In patients with ureteric obstruction secondary to malignancy or medical conditions excluding them from more invasive surgery, EAS provide a further therapeutic option instead of a permanent nephrostomy, which has associated inherent problems. This technique is not without potential problems and careful selection of patients remains vital in this difficult area.
评估解剖外支架（EAS）作为恶性肿瘤继发输尿管梗阻患者尿液改道方法的作用。
先前已描述了在输尿管梗阻患者中插入EAS的技术；迄今为止，已治疗了13例患者（7名女性和6名男性，平均年龄45.3岁，范围22 - 78岁）。所有患者均有肾积水的超声证据和/或肾功能损害的显著生化证据。患者患有晚期恶性肿瘤，1例患者患有腹主动脉瘤。
所有患者尿液改道均成功；2例存活超过1年，每隔6个月更换支架。3例患者因漏尿或感染问题，支架被经皮肾造瘘术取代。其余患者死亡时EAS仍在位且功能正常。
对于恶性肿瘤继发输尿管梗阻或因内科疾病而无法进行更具侵入性手术的患者，EAS提供了一种替代永久性肾造瘘术的进一步治疗选择，永久性肾造瘘术存在一些固有问题。该技术并非没有潜在问题，在这个困难领域中，仔细选择患者仍然至关重要。
