Zadra J A, Jewett M A, Keresteci A G, Rankin J T, St Louis E, Grey R R, Pereira J J
Cancer. 1987 Sep 15;60(6):1353-7. doi: 10.1002/1097-0142(19870915)60:6<1353::aid-cncr2820600632>3.0.co;2-5.
The management of malignant ureteral obstruction (MUO) has undergone major changes due to the availability of percutaneous drainage techniques and new ureteral stents for endoscopic insertion. These procedures are less morbid than conventional surgical techniques so that the indications for urinary diversion due to untreated or relapsing malignancy have to be reconsidered. During the period of technological change from 1978 to 1984, 135 patients with unilateral (37) or bilateral (98) MUO were managed. Open nephrostomy is now almost never necessary. Initial retrograde ureteral stenting (RS) was successful under local anaesthesia in 41% of patients. Forty-seven had percutaneous nephrostomy (PN), nine of whom underwent antegrade ureteral stenting (AS) and elimination of external appliances. Twenty-nine patients underwent miscellaneous open procedures mostly in the earlier years, with a 57% morbidity rate compared to the minimal morbidity associated with the newer techniques. The overall mean survival post diversion was 9.9 months, which is significantly longer than that reported using open procedures. MUO can now be successfully relieved with little morbidity and frequently without the use of external urine collection devices. The relative ease of diversion can complicate decision making in patients with progressive renal failure due to bilateral MUO.
由于经皮引流技术的出现以及用于内镜插入的新型输尿管支架，恶性输尿管梗阻（MUO）的治疗发生了重大变化。这些手术的创伤性比传统手术技术小，因此对于因未治疗或复发性恶性肿瘤而进行尿流改道的指征必须重新考虑。在1978年至1984年的技术变革期间，对135例单侧（37例）或双侧（98例）MUO患者进行了治疗。现在几乎不再需要开放性肾造瘘术。最初的逆行输尿管支架置入术（RS）在局部麻醉下41%的患者中取得成功。47例患者进行了经皮肾造瘘术（PN），其中9例接受了顺行输尿管支架置入术（AS）并去除了外部装置。29例患者大多在早期接受了各种开放性手术，其发病率为57%，而新技术相关的发病率极低。尿流改道后的总体平均生存期为9.9个月，这明显长于采用开放性手术报道的生存期。现在，MUO可以通过微创方式成功缓解，且通常无需使用外部尿液收集装置。对于因双侧MUO导致进行性肾衰竭的患者，相对容易的尿流改道可能会使决策变得复杂。
