Lau M W, Temperley D E, Mehta S, Johnson R J, Barnard R J, Clarke N W
Department of Urology, Christie Hospital NHS Trust, Withington, Manchester, UK.
Br J Urol. 1995 Nov;76(5):565-9. doi: 10.1111/j.1464-410x.1995.tb07779.x.
To determine the survival of patients after percutaneous nephrostomy drainage (PND) for obstructive uropathy secondary to pelvic malignant disease.
The records of 77 patients undergoing PND for obstructive uropathy were reviewed. Patients were classified according to the nature of the obstructing lesion: Group I (primary untreated malignancy, 31 patients); Group II (recurrent malignancy with further treatment, 15 patients); Group III (recurrent malignancy with no further treatment, 12 patients); and Group IV (benign disease as a consequence of previous treatment, 19 patients). Outcome was assessed by survival over a mean follow-up of 20 months (range 2 days-8.3 years).
Overall median survival was 26 weeks, with a 5-year survival of 22%. The survival in Groups I and II was not significantly different (median survival 27 and 20 weeks, respectively; 5-year survival, 10% and 20%, respectively). Group III patients had a poor prognosis (median survival 6.5 weeks) with no patient surviving beyond one year, whilst Group IV patients fared best with a 5-year survival of 64%. The commonest primary tumour type was carcinoma of the cervix (42 patients), and these patients were analysed as a subset. Benign post-radiation fibrosis was found in 16 of 27 patients (59%). Survival was related to the diagnostic group.
The nature and extent of the obstructing lesion and its potential for further treatment are the major determinants of post-nephrostomy survival. Every effort should therefore be made to identify the nature of the obstruction before deciding on PND.
确定盆腔恶性疾病继发梗阻性尿路病患者经皮肾造瘘引流（PND）后的生存率。
回顾了77例因梗阻性尿路病接受PND治疗的患者记录。根据梗阻病变的性质对患者进行分类：第一组（原发性未治疗恶性肿瘤，31例患者）；第二组（复发性恶性肿瘤并接受进一步治疗，15例患者）；第三组（复发性恶性肿瘤且未接受进一步治疗，12例患者）；第四组（既往治疗导致的良性疾病，19例患者）。通过平均20个月（范围2天至8.3年）的随访评估生存情况。
总体中位生存期为26周，5年生存率为22%。第一组和第二组的生存率无显著差异（中位生存期分别为27周和20周；5年生存率分别为10%和20%）。第三组患者预后较差（中位生存期6.5周），无患者存活超过一年，而第四组患者预后最佳，5年生存率为64%。最常见的原发性肿瘤类型为宫颈癌（42例患者），对这些患者作为一个亚组进行了分析。27例患者中有16例（59%）发现良性放疗后纤维化。生存与诊断组相关。
梗阻病变的性质、范围及其进一步治疗的可能性是肾造瘘术后生存的主要决定因素。因此，在决定进行PND之前，应尽一切努力确定梗阻的性质。
