Kearney G P, Docimo S G, Doyle C J, Mahoney E M
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Urology. 1992 Jul;40(1):1-6. doi: 10.1016/0090-4295(92)90426-w.
In the patient with metastatic carcinoma, urinary diversion is usually achieved with indwelling ureteral stents or placement of a percutaneous nephrostomy tube. Most forms of surgical diversion carry an unacceptable morbidity rate, especially in the debilitated patient. Over a fifteen-year period (1974-1989), 29 adult patients with pelvic malignancy (32 ureters) underwent palliative cutaneous ureterostomy. This previously reported technique involves transverse nephropexy and construction of a stoma using a small skin flap. Indications included ureteral obstruction or severe urinary tract symptoms. Hydroureter, often considered a precondition for this procedure, was not present in several patients and was not a prerequisite to success. Complications related to the procedure included one postoperative death due to stroke, one death due to uremia and sepsis, and one instance of severe renal arterial stenosis resulting in renal failure. Preservation of renal function was possible in the 10 patients known to have survived from one to thirteen years postoperatively; only 3 patients eventually required stomal revision. By adherence to the surgical techniques described, the usually high incidence of stomal stenosis was avoided. Our experience reveals that although the indications for cutaneous ureterostomy are limited, this procedure can provide an alternative to permanent nephrostomy drainage or to a higher risk intestinal urinary diversion in carefully selected patients with a reasonable life expectancy.
对于转移性癌患者，通常通过留置输尿管支架或放置经皮肾造瘘管来实现尿液改道。大多数手术改道方式的发病率都令人难以接受，尤其是在身体虚弱的患者中。在15年期间（1974 - 1989年），29例患有盆腔恶性肿瘤的成年患者（32条输尿管）接受了姑息性皮肤输尿管造口术。这种先前报道的技术包括横向肾固定术以及使用小皮瓣构建造口。适应症包括输尿管梗阻或严重的尿路症状。输尿管积水通常被认为是该手术的一个前提条件，但在一些患者中并不存在，也不是成功的必要条件。与该手术相关的并发症包括1例因中风导致的术后死亡、1例因尿毒症和败血症导致的死亡以及1例严重肾动脉狭窄导致肾衰竭的情况。已知有10例患者术后存活了1至13年，肾功能得以保留；最终只有3例患者需要对造口进行修复。通过遵循所描述的手术技术，避免了通常较高的造口狭窄发生率。我们的经验表明，尽管皮肤输尿管造口术的适应症有限，但在精心挑选的预期寿命合理的患者中，该手术可以为永久性肾造瘘引流或风险更高的肠道尿液改道提供一种替代方案。
