Donat S M, Russo P
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Ann Surg Oncol. 1996 Jul;3(4):393-9. doi: 10.1007/BF02305670.
The purpose of this study was to assess the morbidity and determine survival after ureteral decompression in patients with advanced nonurologic malignancies.
Between June 1988 and June 1993 78 patients were referred to a single surgeon for ureteral decompression. Records were analyzed in relation to primary diagnosis, early and late complications, number of hospitalizations, and survival after decompression.
Seventy-two percent of patients initially underwent decompression endoscopically, and 28% required percutaneous nephrostomy placement at initial decompression. Complications occurred in 50% of patients and most commonly included infection (29%), stent obstruction and encrustation (28%), and gross hematuria (9%). The median survival for all patients after the first decompression procedure was 6.8 months (range 0.5-46.1), with an actuarial survival rate at 1 year of 55% and at 3 years of 30%. The eight patients with gastric/pancreatic cancer survived a median of just 1.4 months after decompression (range 0.77-11.8), with a 1-year actuarial survival rate of 12.5% and 3-year actuarial survival of 0%, which was significantly worse when compared with all other groups taken together or individually (p < 0.03).
Ureteral decompression procedures in patients with advanced cancer can be an important component of palliative care but are associated with significant morbidity (50%) in patients whose median survival is < 7 months. The role of ureteral decompression in patients with advanced gastric and pancreatic cancer is limited.
本研究旨在评估晚期非泌尿系统恶性肿瘤患者输尿管减压后的发病率并确定其生存率。
1988年6月至1993年6月期间，78例患者被转介至一位外科医生处接受输尿管减压治疗。对记录进行分析，内容涉及原发性诊断、早期和晚期并发症、住院次数以及减压后的生存率。
72%的患者最初接受了内镜减压，28%的患者在初次减压时需要进行经皮肾造瘘术。50%的患者出现了并发症，最常见的包括感染（29%）、支架阻塞和结痂（28%）以及肉眼血尿（9%）。首次减压手术后所有患者的中位生存期为6.8个月（范围0.5 - 46.1个月），1年的精算生存率为55%，3年为30%。8例胃癌/胰腺癌患者减压后的中位生存期仅为1.4个月（范围0.77 - 11.8个月），1年精算生存率为12.5%，3年精算生存率为0%，与其他所有组合并或单独比较时均显著更差（p < 0.03）。
晚期癌症患者的输尿管减压手术可以是姑息治疗的重要组成部分，但对于中位生存期<7个月的患者，该手术会导致显著的发病率（50%）。输尿管减压在晚期胃癌和胰腺癌患者中的作用有限。
