胃肠恶性肿瘤腹膜后转移致急性肾功能衰竭的诊治

Diagnosis and treatment of postrenal failure from gastrointestinal malignant tumor retroperitoneal metastases involvement

目的探讨胃肠恶性肿瘤腹膜后转移引起肾后性急性肾功能衰竭的诊断治疗。方法对21例晚期胃肠恶性肿瘤(其中直肠癌8例、结肠癌3例、胃癌6例、贲门癌1例、不明原发病灶的转移性腺癌3例腹膜后转移)引起肾后性急性肾功能衰竭患者回顾性的诊治分析。结果行开放肾造瘘7例(包括探查并行开放肾造瘘3例),穿刺肾造瘘5例(后也改为开放肾造瘘),经皮肾穿刺扩张肾造瘘1例,经膀胱镜放置双J管引流2例,膀胱造瘘2例(膀胱出口梗阻),所有经过以上尿液引流的病人肾功能都恢复正常,并且生存时间延长,血液透析2例、放弃治疗2例病人都在较短时间内死于肾功能衰竭及其并发症。结论早期诊断早期治疗肾后性肾功能衰竭可以明显提高了病人的带瘤生存时间,在放置双“J”管引流失败的情况下,肾造瘘是简单、安全、有效的解除肾后性急性肾功能衰竭治疗方法,而不能依赖血液透析治疗。

Objective To evaluate Diagnosis and treatment of postrenal failure caused by retroperitoneal metastases involvement from gastrointestinal malignant tumor. Methods The clinical data of 21cases were reviewed retrospectively in our hospital from 1,2003 to2,2006. Results 12cases were performed open nephrostomy or ureterostomy, 1 cases were performed percutaneous nephrostomy,2cases were put double＂ J＂ ureteral stent via cystoscope ,2cases were performed cystostomy,2cases were perfomed blood dialyses, 2cases refusing treatment. The renal function of all patients were normal after urinary drainage and the span of life is extending. 2cases were perfomed blood dialyses and 2cases no treatment were died in short time. Conclusions Earlier diagnosis and permanent urinary drainage may be necessary for these patients with gastrointestinal metastatic cancer invading renal collective system and ureter as well as orifice of bladder,percutaneous nephrostomy or open nephrostomy or ureterostomy after failure in putting double＂ J＂ ureteral stent is safe and effective instead of blood dialyses.