Wilson J R, Urwin G H, Stower M J
Department of Urology, York District Hospital, York, UK.
Ann R Coll Surg Engl. 2005 Jan;87(1):21-4. doi: 10.1308/1478708051432.
Uraemia as a result of malignant ureteric obstruction is a recognised event in those with advanced malignancy, usually of pelvic origin, which, if left untreated, is quickly a terminal event. Palliative decompression of the obstructed urinary system, either by percutaneous nephrostomy (PCN), ureteric stent or a combination of both is a recognised method of improving renal function, with presumed low morbidity. The aims of the study were to assess whether PCN placement in malignant ureteric obstruction provided any additional survival benefit or patient morbidity.
The case notes of 32 patients with a mean age of 68.1 years (16 male, 16 female) who underwent PCN drainage for malignant ureteric obstruction were retrospectively analysed. Data on the site of primary malignancy, mode of presentation, improvement in renal function, median survival, conversion to internal ureteric stents and intervention-related complications were collected for analysis.
The median survival following PCN insertion was 87 days and was unrelated to the patient's age and renal function. Those patients with primary underlying gynaecological malignancies appeared to survive almost 4 times as long as those with underlying primary bladder cancer. Renal function took a mean of 16.8 days to reach a nadir. Almost 79% of patients were able to be discharged from hospital--each patient, however, being re-admitted back to hospital on average 1.6 times prior to their death through PCN or internal ureteric stent related events. Retrospective "useful quality of life" was seen in less than half of the patient cohort.
In the presence of malignant ureteric obstruction, palliative percutaneous urinary diversion may be performed and is effective in improving renal function. However, long-term survival is limited and should, therefore, be performed only when the views and wishes of the patient and carers are taken into account and if there is a definitive treatment plan available for the patient as quality of life can be suboptimal.
恶性输尿管梗阻导致的尿毒症在晚期恶性肿瘤患者中是一种公认的情况，通常起源于盆腔，如果不治疗，很快就会发展为终末期事件。通过经皮肾造瘘术（PCN）、输尿管支架置入或两者结合对梗阻性泌尿系统进行姑息性减压是一种公认的改善肾功能的方法，推测其发病率较低。本研究的目的是评估在恶性输尿管梗阻中放置PCN是否能带来额外的生存益处或患者发病率。
回顾性分析了32例平均年龄为68.1岁（16例男性，16例女性）因恶性输尿管梗阻接受PCN引流的患者的病历。收集了关于原发性恶性肿瘤部位、临床表现方式、肾功能改善情况、中位生存期、转为输尿管内支架置入以及与干预相关的并发症的数据进行分析。
PCN置入后的中位生存期为87天，与患者年龄和肾功能无关。那些原发性妇科恶性肿瘤患者的生存期似乎是原发性膀胱癌患者的近4倍。肾功能平均需要16.8天达到最低点。近79%的患者能够出院——然而，每位患者在因PCN或输尿管内支架相关事件死亡前平均再次入院1.6次。不到一半的患者队列有回顾性的“有用生活质量”。
在存在恶性输尿管梗阻的情况下，可以进行姑息性经皮尿液转流，并且在改善肾功能方面是有效的。然而，长期生存是有限的，因此，只有在考虑患者和护理人员的意见和意愿并且有明确的患者治疗计划时才应进行，因为生活质量可能不理想。
