肾盂膀胱皮下输尿管旁路术治疗晚期肿瘤的输尿管梗阻

Surgical treatment of ureteral obstruction produced by advanced metastatic cancer with nephrovesical subcutaneous ureteric bypass

目的探讨肾盂膀胱皮下输尿管旁路术治疗晚期肿瘤患者单侧或双侧输尿管梗阻的手术体会及远期效果。方法回顾性分析15例晚期肿瘤(结肠癌、直肠癌术后6例,宫颈癌、卵巢癌9例)患者行17例次肾盂膀胱皮下输尿管旁路术的手术资料及随访情况。结果 15例患者中,2例为双侧输尿管梗阻,行17例次手术,手术均成功,无严重手术并发症。单侧手术时间为(35±12)min。血肌酐由术前的(264±117)μmol/L降低为术后的(113±26)μmol/L(P<0.05);术前生活质量评分(4.2±1.6)分,术后为(7.2±2.4)分(P<0.05)。术后肾盂内感染致梗阻1例;2例患者术后8个月时因梗阻更换导管。结论晚期肿瘤患者转移性病变压迫输尿管引起肾积水,行肾盂膀胱皮下输尿管旁路术创伤小,可有效缓解肾积水、保护肾功能,改善生活质量。

Objective To investigate the efficacy of treating ureteral obstruction produced by advanced metastatic cancer with nephrovesical subcutaneous ureteric bypass.Methods Data of 15 cases with ureteral obstruction produced by advanced metastatic cancer（6 cases of colorectal cancer,9 cases of cervical cancer and ovarian cancer） treated with 17 times of nephrovesical subcutaneous ureteric bypass were retrospectively analyzed.Serum creatinine,quality of life score,and renal ultrasonography were evaluated during follow-up.Results Of 15 patients,bilateral obstructions occurred in 2 cases.The surgeries were all successful without severe postoperative complication.The mean operation time was（35±12） min.Serum creatinine was reduced from（264±117） μmol/L before to（113±26） μmol/L after operation（P0.05）.The quality of life score was elevated from（4.2±1.6） points to（7.2±2.4） points postoperatively（P0.05）.One case had pelvis infection postoperatively.The tuber system had to be replaced due to occlusion at 8 months in 2 patients.Conclusion The nephrovesical ureteric bypass is a minimally invasive and effective treatment for the patients with hydronephrosis resulted from advanced metastatic cancer,which benefits protection of renal function and improvement of life quality.