Soper J T, Blaszczyk T M, Oke E, Clarke-Pearson D, Creasman W T
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, N.C. 27710.
Am J Obstet Gynecol. 1988 May;158(5):1126-31. doi: 10.1016/0002-9378(88)90237-2.
Percutaneous nephrostomies were used in 34 patients with ureteral obstruction caused by gynecologic diseases. Group 1 consisted of 12 patients with untreated cervical carcinoma; group 2 consisted of six patients with recurrent cervical carcinoma; group 3 consisted of seven patients with complications of urinary conduits, and group 4 consisted of eight patients with a variety of malignant and benign gynecologic diseases causing ureteral obstruction. One perinephric hematoma and one perinephric abscess (4%) occurred during primary percutaneous nephrostomy diversion of 53 renal units. One (3%) percutaneous nephrostomy-related death caused by sepsis was observed in 34 patients. Only four (12%) patients with significant intrinsic renal disease did not have effective normalization of renal function by percutaneous nephrostomy. Percutaneous nephrostomies allow rapid and reliable urinary diversion without the morbidity and mortality of operative techniques. Percutaneous nephrostomy should be considered for relief of ureteral obstruction in patients with untreated cervical carcinoma who may enjoy prolonged palliation or cure, in patients with complications of previous urinary conduits as a temporizing method of urinary diversion, and in patients with benign or chemotherapy-sensitive pelvic malignancies causing ureteral obstruction. The use of percutaneous nephrostomy in patients with recurrent carcinoma of the cervix should be individualized on the basis of expectations for prolonged functional palliation.
34例因妇科疾病导致输尿管梗阻的患者接受了经皮肾造瘘术。第1组包括12例未经治疗的宫颈癌患者；第2组包括6例复发性宫颈癌患者；第3组包括7例尿流改道术并发症患者；第4组包括8例因各种恶性和良性妇科疾病导致输尿管梗阻的患者。在对53个肾单位进行初次经皮肾造瘘引流期间，发生了1例肾周血肿和1例肾周脓肿（4%）。在34例患者中，观察到1例（3%）因败血症导致的经皮肾造瘘相关死亡。只有4例（12%）有严重内在性肾病的患者经皮肾造瘘术后肾功能未有效恢复正常。经皮肾造瘘术可实现快速可靠的尿液引流，且无手术技术带来的发病率和死亡率。对于可能获得长期姑息治疗或治愈的未经治疗的宫颈癌患者、作为尿液引流临时方法的既往尿流改道术并发症患者以及因良性或化疗敏感的盆腔恶性肿瘤导致输尿管梗阻的患者，应考虑行经皮肾造瘘术以缓解输尿管梗阻。对于复发性宫颈癌患者，经皮肾造瘘术的使用应根据对长期功能姑息治疗的预期进行个体化决策。
