输尿管内留置双J管治疗晚期恶性肿瘤继发的输尿管梗阻

Indwelling double-J ureteral stents for secondary ureteral obstruction in advanced malignant tumors

目的探讨输尿管内留置双J管治疗晚期恶性肿瘤继发的输尿管梗阻的疗效。方法采用输尿管内逆行留置双J管治疗23例晚期恶性肿瘤继发的输尿管梗阻。结果本组单侧梗阻8例，初次置管成功5例（62．5％）；双侧梗阻15例，初次置管成功17侧（56．7％）。置管成功后，肾积水均有不同程度缓解，术前升高的血肌酐术后复查均有不同程度好转。初次成功置管后输尿管再发梗阻2例，发生在初次置管后第1天、第3天。术后随访1～26个月，平均8个月，13例（56．5％）死于肿瘤晚期合并多脏器功能衰竭；10例（43．5％）现存活，其中7例输尿管内置管已达1—26个月，病情稳定。输尿管内置管失败后行经皮肾穿刺造瘘术（PCN）。本组无操作相关性死亡。结论输尿管内留置双J管可作为晚期恶性肿瘤继发的输尿管梗阻的首选治疗方案。

Objective Toinvestigate the efficacy of indwelling double-J ureteral stents for sec- ondary ureteral obstruction in advanced malignant tumors. Methods Twenty-three patients with advanced malignancies were treated with indwelling retrograde double-J stents for ureteral obstruction. Results Eight patients had unilateral ureteral obstruction and 5 cases of the catheterization（62.5% ）succeed ini- tially. Fifteen patients had bilateral ureteral obstruction and 17 sides of the catheterization succeed initially （56.7%）. After the catheterization, the hydronephrosis and serum creatinine levels were improved. Two patients who had successful stent placement presented with stent failure on the first and third day after the first catheterization. The follow-up after the initial stent insertion was 1 to 26 months, with an average of g months. Thirteen patients died from advanced malignant tumors and multiple organ failure. In the remaining 10 patients,7 continued their treatment with ureteral stents. The patients underwent percutaneous nephros- tomy （PCN）after the failure of catheterization. No death was associated with the procedures. Conclusion Indwelling double-J ureteral stents can be considered as the first-line treatment in patients with secondary ureteral obstruction in advanced malignant tumors.