恶性肿瘤继发双侧输尿管梗阻的腔内治疗

Endoluminal therapy for bilateral malignant ureteric obstruction

目的分析腔内泌尿外科技术治疗恶性肿瘤继发双侧输尿管梗阻。方法回顾性分析43例(70例次)恶性肿瘤继发双侧输尿管梗阻患者应用腔内技术治疗的疗效。在治疗的70例次中,应用逆行输尿管镜置管术38例次,微创经皮肾穿刺造瘘术(MPCN)24例次,顺行输尿管镜置管术8例次。结果43例患者术后平均随访12个月。逆行输尿管镜置管术、MPCN术和顺行输尿管镜置管术的治疗成功率分别为50.0%(19/38)、100.0%(24/24)和62.5%(5/8)。肿瘤侵袭输尿管开口(13/38)和严重腔外梗阻(6/38)是导致逆行输尿管镜置管术失败的主要原因;严重腔外梗阻(3/8)是导致顺行输尿管镜置管术失败的主要原因;术后肾造瘘管脱出(11/19)是限制MPCN应用的主要因素。结论腔内技术治疗恶性输尿管梗阻是安全、有效的。逆行输尿管镜置管术是本病的首选治疗方法,但对于肿瘤侵袭输尿管开口或严重腔外梗阻患者,可根据梗阻的部位和程度选用MPCN术或顺行输尿管镜置管术。

Objective To evaluate the endourological technique in the treatment of bilateral malignant ureteric obstruction. Methods The data of 43 patients （totally, 70 cases ） with bilateral malignant ureteric obstruction treated with endoluminal therapy were reviewed retrospectively. Of 70 cases, 38 were treated by retrograde double-J stenting, 24 by minimally invasive percutaneous nephrotomy（MPCN） and 8 by antegrade double-J stenting. Results All patients were followed up for an average of 12 months. The retrograde double-J stenting, MPCN and antegrade double-J stenting was successfully performed in 50.0% （ 19/38 ）, 100. 0% （ 24/24 ） and 62. 5% （ 5/8 ）, respectively. Technical failures in placing retrograde double-J stent were too difficult to identify the ureteric orifice （13/38） or failing to cross the obstruction site because of severe extraluminal compression （6/38）. Failure in placing antegrade double-J stent was due to severe extraluminal compression （3/8）. Dislodgment of nephrostomy tubes （11/19） was the major factor which limited the application of MPCN. Conclusion It is safe and effective to treat malignant ureteric obstruction with endourological technique, and suggested initially with retrograde double-J stenting. If malignant ureteric orifice occlusion or a severe extraluminal compression is showed in the imaging, MPCN or antegrade double-J stenting may be selected according to the site and the extent of obstruction.