Olivo J F, Le Joliff L, Artagnan J, Lobel B
Service d'Urologie, CHU Pontchaillou, Rennes.
J Urol (Paris). 1987;93(6):353-5.
The problem raised is that of the legitimacy of palliative urinary derivation in the malignant tumours of the pelvis beyond any therapeutic possibility. Between 1980 and 1985, 49 patients were referred to the department of Urology of Rennes for cutaneous ureterostomy type. 39 records were suitable for review. Bilateral ureteric obstruction in the course of carcinomas of the pelvis, regardless of the origin, is uncommon bearing in mind the prevalence of such pathology and notably in women. Recent techniques (J catheter, per-cutaneous nephrostomy) have simplified the surgical procedure of urinary bypass. They do not fundamentally change the incisions and are not always applicable. Use of the J catheter may be prevented by the impossibility of intubating the ureter or when the bladder is unusable as a reservoir, whilst the use of percutaneous nephrostomy is hazardous or possibly even insufficient to dry the perineum when there is a malignant vesicovaginal fistula. This study involved evaluation of 39 patients who underwent uni or bilateral terminal cutaneous ureterostomy, any other technique having proved to be undesirable. The mean survival of the patients was 225 days and its quality as good or satisfactory in only 25% of cases. The implantation of epidural morphine reservoirs may improve the quality of survival of these patients by suppressing pain which up to now has been an absolute contraindication to an upper cutaneous derivation procedure.
所提出的问题是，在盆腔恶性肿瘤已无任何治疗可能性的情况下，姑息性尿路改道的合理性问题。1980年至1985年间，有49例患者因行皮肤输尿管造口术被转诊至雷恩泌尿外科。39份记录适合进行回顾性研究。考虑到此类病理情况的普遍性，尤其是在女性中，盆腔癌病程中出现双侧输尿管梗阻并不常见。近期的技术（J形导管、经皮肾造瘘术）简化了尿路改道的手术过程。它们并未从根本上改变手术切口，且并非总是适用。当输尿管插管不可能或膀胱无法用作储尿器时，J形导管的使用可能会受到阻碍，而当存在恶性膀胱阴道瘘时，经皮肾造瘘术有风险，甚至可能不足以使会阴部干燥。本研究对39例行单侧或双侧末端皮肤输尿管造口术的患者进行了评估，因为已证明其他任何技术都不合适。患者的平均生存期为225天，仅25%的病例其生存质量良好或令人满意。硬膜外吗啡储器的植入可能通过抑制疼痛来提高这些患者的生存质量，而疼痛迄今为止一直是上腹部皮肤改道手术的绝对禁忌证。
