Departments of Urology and Radiology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA.
J Endourol. 2013 May;27(5):646-51. doi: 10.1089/end.2012.0552. Epub 2013 Feb 14.
We present our experience with the use of metallic stents (Wallstents®) in the management of malignant ureteral obstruction to maintain renal function, thereby permitting the use of chemotherapeutic agents to treat the underlying malignancy.
We retrospectively reviewed the records of 24 patients with ureteral obstruction secondary to advanced cervical carcinoma, stage T3b (n=10) and T4 (n=14), that was relieved by Wallstents. Nineteen patients needed bilateral and 5 needed unilateral Wallstents to relieve the obstruction. Fifty-six additional endourologic interventions were necessary to assure continued patency. Holmium laser ablation was used 14 times to manage tumor proliferation and ingrowth at the distal end of the stent. Thirty-two endostents, 4 extension, and 6 replacement stents were used to maintain patency of the ureter.
Nineteen of our 24 patients received between one and five chemotherapeutic cycles over 18 to 140 months. In five patients, placement of Wallstents did not achieve adequate decrease of the creatinine levels to allow treatment with chemotherapy. Thirteen of 24 Wallstents remained patent over 18 months, yielding a primary patency rate of 54%. Technical success rate of Wallstent placement was 100%. The overall mean primary and secondary patency rates of the stent were 16.5 and 52 months, respectively. For T3b and T4 patients, the mean primary patency rates were 20.6 and 13.6 months, respectively. Secondary patency for T3b patients was 73.9 months vs 36.4 months for T4 patients. There were no serious complications associated with Wallstent placement.
Wallstents offer a salutary solution to the problem of maintaining prolonged patency of ureters compromised by encasing neoplasms.
我们介绍了使用金属支架（Wallstents®）治疗恶性输尿管梗阻以维持肾功能的经验，从而允许使用化学治疗剂治疗潜在的恶性肿瘤。
我们回顾性地分析了 24 例因晚期宫颈癌（T3b 期 10 例，T4 期 14 例）导致输尿管梗阻而接受 Wallstents 治疗的患者的记录。19 例患者需要双侧，5 例需要单侧 Wallstents 来缓解梗阻。为了确保持续通畅，还需要进行 56 次额外的腔内泌尿科干预。钬激光消融术用于处理支架远端肿瘤增殖和向内生长共 14 次。使用 32 个内支架、4 个延伸支架和 6 个替换支架来维持输尿管通畅。
24 例患者中有 19 例接受了 1 至 5 个化疗周期，时间为 18 至 140 个月。在 5 例患者中，放置 Wallstents 并没有降低肌酐水平以允许使用化疗。24 个 Wallstents 中有 13 个在 18 个月以上保持通畅，原发性通畅率为 54%。Wallstents 放置的技术成功率为 100%。支架的总体平均原发性和继发性通畅率分别为 16.5 和 52 个月。对于 T3b 和 T4 患者，原发性通畅率分别为 20.6 和 13.6 个月。T3b 患者的继发性通畅率为 73.9 个月，而 T4 患者为 36.4 个月。Wallstents 放置没有严重并发症。
Wallstents 为维持被包裹的肿瘤引起的输尿管长期通畅提供了一种有益的解决方案。
