不同手术方法置入金属支架管治疗肿瘤性输尿管梗阻的疗效研究

Metallic stents with different method for alleviating malignant ureteral obstruction

摘要:

摘要：目的 研究不同方法置入金属输尿管支架管治疗肿瘤性输尿管梗阻的经验及疗效。方法 回顾性分析2014年6月－2018年4月该科收治的14例因腹、盆腔恶性肿瘤导致输尿管梗阻的患者资料，分别采用膀胱镜下置管术、输尿管镜下置管术、经皮肾镜顺行置管术以及膀胱切开输尿管置管术4种手术方式，术后随访观察疗效及并发症等情况。结果 14例患者均置管成功，术后肾积水均有不同程度缓解，术前、术后第7天肌酐值分别为（351.55±196.50）和（124.85±39.15）μmol/L，差异有统计学意义（P =0.014）。术后平均随访11个月，金属支架管平均留置时间为12个月，留置时间最长约2年，置管后未发生二次梗阻。死亡2例，12例存活至今，门诊复查未见支架管断裂、移位、失功和结石等，患者无明显异物感、无引流不畅，2例间断性出现肉眼血尿，1例术后反复尿路感染，另1例身体一般状况差，未能按时门诊复查。结论 金属输尿管支架用于治疗肿瘤性输尿管梗阻安全有效，由于不同患者的手术情况不同，可灵活选择不同的置入方法。

Abstract:

Abstract: Objective To study clinical experiences and outcomes of metallic ureteral stent with different method in treating the patients of malignant ureteral obstruction. Method The retrospective study enrolled 14 patients of abdominal or pelvic malignant tumor received metallic ureteral stent placement because of ureteral obstruction from Jun 2014 to Aug 2018. Its operation methods are listed as followed: metallic ureteral stent placement under cystoscope or ureteroscopy, nephroscope through anterograde approach, and bladder incision. Outcomes and complications were observed during follow-up. Results All the operations in this group were successful, the kidney seeper was improved. Respectively analyze the creatinine value before surgery and at day 7 after surgery was (351.55 ± 196.50) μmol/L, (124.85 ± 39.15) μmol/L, there is statistically significant (P = 0.014). The mean follow-up was 11 months. The average retention time of metallic stent was about 12 months, and the longest was about 2 years. No secondary obstruction occurred after the operations, 2 cases died, 12 survived. The KUB showed that no fracture, displacement, loss of function and stone were found in the metallic stents to patients reviewed from outpatients, and they had no poor drainage, no obviously uncomfortable feeling. 2 cases occurred intermittent hematuria, and 1 case occurred repeated urinary tract infections after operation. The other 1 case was in poor condition and were not reviewed on time. Conclusions Metallic ureteral stents are safe and effective for patients of malignant ureteral obstruction. Due to different operation conditions,different methods can be selected flexibly.