经皮下肾膀胱分流手术的临床应用

Clinical application of subcutaneous nephrovesical bypass system

目的:探讨经皮下肾膀胱分流手术在治疗输尿管梗阻患者中的应用价值。方法:晚期盆、腹腔恶性肿瘤患者36例,男18例,女18例,平均年龄60岁(37～82岁),其中双侧输尿管梗阻9例,右侧输尿管梗阻19例,左侧输尿管梗阻8例。B超检查显示患侧的平均肾盂积水宽度3.2cm(1.8～5.2cm),血清肌酐水平261μmol/L(73～760μmol/L),患肾的肾小球滤过率为22mL/min(19～26mL/min),逆行造影显示患侧输尿管完全梗阻。使用肾膀胱分流套件,共行经皮下肾膀胱分流手术45次。术后复查B超、立位腹平片(KUB)、血清肌酐水平以及肾小球滤过率。结果:36例患者均手术顺利,成功放置肾膀胱分流导管。术后72h复查B超,平均肾积水宽度0.6cm(0～1.8cm),导管位置良好,血清肌酐水平105μmol/L(72～173μmol/L),肾小球滤过率33mL/min(25～40mL/min)。患者术后生活质量评价均较术前有所改善。平均随访时间305天(67～481天)。结论:经皮下肾膀胱分流手术操作简单、微创,可有效保护因输尿管梗阻而损害的肾脏功能,明显减少肾造瘘的并发症,提高了患者的生活质量。

Objective：To evaluated the subcutaneous nephrovesical bypass carried out in patients with ureter obstruction and improve the quality of life of patients with palliative definitive percutaneous nephrostomy.Methods：A total of 36 patients with advanced cancer receiving 45 subcutaneous nephrovesical bypass tubes were included in the study.Uronephrosis ranged from 1.8-5.2 cm,serum creatinine 73-760 μmol/L,and glomerular filtration rate（GFR） 19-26 mL/min.The obstruction was proved to be complete by retrograde pyelography.The nephrovesical stents were inserted utilizing percutaneous access to both of the kidney and bladder,and a subcutaneous tunnel was created between the two sites.B-ultrasound,KUB（kidneys,ureters,and bladder）,serum creatinine test and GFR were carried out 72 hours after operation.Results：Urinary diversion operations were successful in the 36 patients,uronephrosis ranged from 0-1.8 cm,all stents were in position,serum creatinine 72-173 μmol/L,GFR 25-40 mL/min after the operation,and the bypass functioned well in 45 stents for 67 to 481 days of the follow-up.Conclusion：Subcutaneous nephrovesical bypass can protect renal function of patients suffering from ureteral obstruction by simple and minimum invasive operation;it can also reduce complications caused by percutaneous nephrostomy and improve the patient＇s life quality.