Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Medical Imaging, Cardinal Tien Hospital, School of Medicine Fu-Jen Catholic University, New Taipei City, Taiwan.
J Endourol. 2021 Jun;35(6):912-918. doi: 10.1089/end.2017.0611. Epub 2018 Feb 12.
We provide primary patency rate of metallic ureteral stents in cancer patients and investigate the factors affecting primary patency. All cancer patients who had received metallic stents for malignant ureteral obstruction between July 2009 and November 2012 in our institute were included. No patients were excluded. Patient profiles, imaging studies, and laboratory data were collected. Patient profiles included age, gender, body height, body weight, body mass index, cancer types, treatment for cancer, response to cancer treatment, methods of stent insertion, and prior ordinary stents. Imaging studies included renal ultrasonography, antegrade pyelography, CT, and MRI. Laboratory data included urinalysis, urine culture, and serum creatinine. Complications were defined according to the Clavien-Dindo classification. Primary patency was defined as a complete resolution or downgrading of hydronephrosis shown by imaging studies or success in the removal of a preexisting nephrostomy tube; otherwise the procedure was considered a primary failure. The primary endpoint was the primary patency rate of the stents. The secondary endpoints were risk factors for primary stent failure. A total of 124 stents were inserted into 96 patients with malignant ureteral obstruction. There were no grade 3/4 complications. The overall primary patency rate was 87.9% (109/124). In univariate analysis, antegrade insertion (OR = 24.15, -value = 0.0086) and urinary tract cancer (OR = 4.18, -value = 0.0164) were significantly associated with primary failure. Those with prior ordinary stents (OR = 0.20, -value = 0.0158) or response to cancer treatment (OR = 0.25, -value = 0.0228) were associated with stent patency. In multivariate analysis, antegrade insertion (OR = 22.04, -value = 0.0041) and response to cancer treatment (OR = 0.15, -value = 0.01081) remained significant factors. In this large cohort of cancer patients requiring urinary diversion to preserve renal function, several factors were associated with the success rate of metallic stents.
我们提供了癌症患者金属输尿管支架的主要通畅率，并研究了影响主要通畅率的因素。本研究纳入了 2009 年 7 月至 2012 年 11 月在我院因恶性输尿管梗阻接受金属支架治疗的所有癌症患者。没有排除任何患者。收集了患者资料、影像学研究和实验室数据。患者资料包括年龄、性别、身高、体重、体重指数、癌症类型、癌症治疗、癌症治疗反应、支架插入方法和先前的普通支架。影像学研究包括肾脏超声、逆行肾盂造影、CT 和 MRI。实验室数据包括尿分析、尿培养和血清肌酐。并发症根据 Clavien-Dindo 分类定义。主要通畅定义为影像学研究显示完全缓解或肾积水降级或成功取出先前存在的肾造口管；否则，该程序被认为是主要失败。主要终点是支架的主要通畅率。次要终点是主要支架失败的危险因素。共对 96 例恶性输尿管梗阻患者的 124 个支架进行了插入。无 3/4 级并发症。总体主要通畅率为 87.9%（109/124）。在单因素分析中，顺行插入（OR=24.15，P 值=0.0086）和尿路上皮癌（OR=4.18，P 值=0.0164）与主要失败显著相关。有先前普通支架（OR=0.20，P 值=0.0158）或癌症治疗反应（OR=0.25，P 值=0.0228）与支架通畅相关。多因素分析显示，顺行插入（OR=22.04，P 值=0.0041）和癌症治疗反应（OR=0.15，P 值=0.01081）仍然是显著因素。在这一大群需要尿路改道以保留肾功能的癌症患者中，有几个因素与金属支架的成功率相关。
