Hoe J W, Tung K H, Tan E C
Department of Radiology, National University of Singapore.
Br J Urol. 1993 Apr;71(4):469-72. doi: 10.1111/j.1464-410x.1993.tb15995.x.
Twenty-two patients with advanced cancer involving the pelvis were treated by percutaneous uroradiological techniques. Percutaneous nephrostomy was performed for renal failure or urosepsis or before chemotherapy. In 8 patients, ureteric stents were also placed by the antegrade route, across malignant ureteric strictures, following nephrostomy. In another 8 patients, the ureteric obstruction could not be crossed and permanent nephrostomies were required. Fifteen patients were able to achieve a useful life but in the other 7 patients there was no improvement in their quality of life and they all died 1 month after intervention. Percutaneous nephrostomy also contributed to the death of 1 patient. Not all obstructed kidneys require drainage and in patients with disseminated or advanced disease involving the pelvis, the indications for intervention need to be individually assessed. An improvement in laboratory criteria of renal function following intervention does not necessarily result in improvement in quality of life. This retrospective study highlights the difficulty in selection of patients with advanced disease for intervention and previously suggested guidelines for intervention are reviewed.
22例骨盆部晚期癌症患者接受了经皮泌尿放射技术治疗。对肾衰竭、尿脓毒症患者或在化疗前进行了经皮肾造瘘术。8例患者在肾造瘘术后还通过顺行途径放置了输尿管支架，跨越恶性输尿管狭窄。另外8例患者输尿管梗阻无法跨越，需要进行永久性肾造瘘术。15例患者能够获得有意义的生活，但另外7例患者生活质量没有改善，均在干预后1个月死亡。经皮肾造瘘术还导致1例患者死亡。并非所有梗阻性肾脏都需要引流，对于骨盆部有播散性或晚期疾病的患者，干预指征需要进行个体化评估。干预后肾功能实验室指标的改善不一定能导致生活质量的提高。这项回顾性研究突出了选择晚期疾病患者进行干预的困难，并对先前建议的干预指南进行了综述。
