Thrasher J B, Wettlaufer J N
Department of Surgery, Fitzsimons Army Medical Center, Aurora, Colorado.
J Urol. 1991 Oct;146(4):977-9. doi: 10.1016/s0022-5347(17)37979-x.
Transureteroureterostomy was combined with terminal loop cutaneous ureterostomy, without complications, in 8 patients with advanced pelvic malignancy and a poor prognosis. Urinary diversion was palliative in all patients and followed pelvic exenteration in 4, debulking of pelvic tumor in 2 and radical cystectomy in 1, while 1 had inoperable bladder cancer. All patients had at least unilateral hydroureteronephrosis preoperatively. In each case a postoperative excretory urogram revealed significant improvement of the hydroureteronephrosis and the serum creatinine improved or stabilized. No patient had ureteral stomal stenosis or retraction. Mean survival was 5 months, with the longest survival being 1 year. Transureteroureterostomy in conjunction with terminal loop cutaneous ureterostomy is an effective technique of urinary diversion in selected patients with a poor prognosis and advanced pelvic malignancy, decreasing operative time while avoiding the morbidity associated with a ureterointestinal operation or nephrostomy.
在8例盆腔恶性肿瘤晚期且预后较差的患者中，输尿管-输尿管吻合术联合末袢皮肤输尿管造口术，未出现并发症。所有患者的尿液改道均为姑息性，其中4例在盆腔脏器清除术后进行，2例在盆腔肿瘤减瘤术后进行，1例在根治性膀胱切除术后进行，另有1例患有无法手术切除的膀胱癌。所有患者术前均至少有单侧输尿管积水和肾盂积水。每例患者术后排泄性尿路造影显示输尿管积水和肾盂积水有显著改善，血清肌酐水平改善或稳定。没有患者出现输尿管造口狭窄或回缩。平均生存期为5个月，最长生存期为1年。输尿管-输尿管吻合术联合末袢皮肤输尿管造口术是一种有效的尿液改道技术，适用于预后较差且患有晚期盆腔恶性肿瘤的特定患者，可减少手术时间，同时避免输尿管肠道手术或肾造瘘术相关的发病率。
