Stevens A, van Driel M F, Klein J P, de Ruiter A J, Mensink H J
Afd. Urologie, Academisch Ziekenhuis, Groningen.
Ned Tijdschr Geneeskd. 1994 Mar 5;138(10):522-5.
To determine indications and results of endourological upper urinary tract drainage in patients with obstruction due to malignancy.
Retrospective.
University Hospital Groningen.
In the period 1987-1992, 57 patients with upper urinary tract obstruction due to cancer were treated primarily with a double-J stent (n = 21) or a percutaneous nephrostomy (n = 36, later replaced by a double-J stent in 13).
Indications were: severe renal failure following bilateral ureteral obstruction due to malignancy (n = 17), or unknown cause (n = 19), to optimise a compromised kidney function before chemotherapy (n = 7), to resolve pain caused by unilateral obstruction (n = 10), or other (n = 4). The tumours originated most often in the cervix uteri, followed by the urinary bladder, the prostate and the corpus uteri. Minor complications occurred in 34 of the 57 patients (60%): transient haematuria (22 x), urgency caused by the distal tip of the double-J catheter (8 x), dislocation (17 x) or obstruction (6 x) of the nephrostomy catheter. Major complications were observed in 5 patients with a double-J stent: sepsis (1 x), catheter break (1 x), ureteral perforation (2 x) and fistulization between the ureter and iliac artery (1 x). Survival after drainage varied from several days to 8 years (mean 23 months). In 5 patients treated with drainage only to prolong survival, survival was 0.5-16 months (mean 7.3).
Endourological drainage may be applied to patients with localised disease, in whom further therapy holds the promise of prolonged survival. However, in view of the low complication rate, selected patients who are on a palliative course and still have rapidly progressive disease can also benefit from extended life-time after endourological drainage.
确定因恶性肿瘤导致梗阻的患者行腔内泌尿外科上尿路引流的适应证及结果。
回顾性研究。
格罗宁根大学医院。
在1987年至1992年期间，57例因癌症导致上尿路梗阻的患者主要接受双J支架置入术（n = 21）或经皮肾造瘘术（n = 36，其中13例后来更换为双J支架）治疗。
适应证包括：因恶性肿瘤导致双侧输尿管梗阻后的严重肾衰竭（n = 17），或病因不明（n = 19），化疗前优化受损肾功能（n = 7），缓解单侧梗阻引起的疼痛（n = 10），或其他（n = 4）。肿瘤最常起源于子宫颈，其次是膀胱、前列腺和子宫体。57例患者中有34例（60%）发生轻微并发症：短暂性血尿（22例）、双J导管远端引起的尿急（8例）、肾造瘘导管移位（17例）或梗阻（6例）。接受双J支架治疗的5例患者出现严重并发症：脓毒症（1例）、导管断裂（1例）、输尿管穿孔（2例）和输尿管与髂动脉之间形成瘘管（1例）。引流后的生存时间从数天到8年不等（平均23个月）。5例仅为延长生存期而接受引流治疗的患者，生存时间为0.5至16个月（平均7.3个月）。
腔内泌尿外科引流可应用于局限性疾病患者，这些患者进一步治疗有望延长生存期。然而，鉴于并发症发生率较低，处于姑息治疗阶段且仍患有快速进展性疾病的特定患者也可从腔内泌尿外科引流后延长的生存期获益。
