经皮下肾膀胱分流术治疗盆腹腔晚期肿瘤引起的输尿管梗阻

Subcutaneous Nephrovesical Bypass for Ureteral Obstruction Due to Advanced Abdominopelvic Malignant Tumors

目的探讨经皮下肾膀胱分流术治疗盆腹腔晚期肿瘤引起的输尿管梗阻的临床价值。方法2009年12月～2012年5月，15例晚期腹腔盆腔肿瘤致输尿管中下段梗阻患者，双侧1例，左侧8例，右侧6例，经输尿管镜置入双J管失败。超声检查显示患侧肾盂积水宽度3．3～8．9cm，（4．2±2．6）cm。磁共振水成像显示患侧输尿管完全梗阻。使用美国巴德公司肾膀胱分流套件，行经皮下肾膀胱分流术15例（16侧）。术后复查超声、KUB平片、血肌酐及患侧肾小球滤过率。结果手术均成功，术后1周复查超声，患侧肾积水宽度1．7—4．6cm，（2．6±1．8）cm（与术前相比，t=5．356，P=0．025）。血肌酐由（256±46）μmol／L下降至（124±23）μmol／L（t=12．351，P=0．006）。患侧肾小球滤过率由（25．4±4．8）ml／min上升至（45．6±5．3）ml／min（t=3．784，P=0．016）。结论经皮下肾膀胱分流术简单易行，创伤小，能改善因输尿管梗阻而受损的肾功能，提高生活质量。

Objective To explore the value of subcutaneous nephrovesical bypass for ureteral obstruction due to advanced abdominopelvic malignant tumors. Methods From December 2009 to May 2012, 15 cases of ureteral obstruction due to advanced pelvic malignant tumors （bilateral, 1 case; left-sided, 8 cases; righ-sided, 6 eases） underwent a failed ureteral eatheterization under ureteroscope. Ultrasound tests showed the average width of hydronephrosis was （4.2± 2.6） em. MRU results showed ureters were completely obstructed. All the patients were given subcutaneous nephrovesical bypass operation by renal bladder diversion package. Serum creatinine, glomerular filtration rate, and renal ultrasonography were evaluated during follow-up visits. Results All the 15 patients （16 lesions） underwent subcutaneous nephrovesical bypass successfully. One week after surgery, ultrasound results showed the average width of hydronephrosis was （2.6 ± 1.8） cm, with significant difference as compared with preoperative measures （ t = 5. 356, P = 0. 025 ）. After surgery, serum creatinine decreased significantly from （256 ：t： 46） i.±mol/L to （ 124 ± 23 ） μmol/L （ t = 12. 351, P = 0. 006） , and glomerular filtration rates increased from （25.4 ± 4.8 ） ml/min to （45.6 ±5.3 ） ml/min （ t = 3. 784, P = 0.016）. Conclusion The subcutaneous nephrovesical bypass is simple, minimally invasive, and less painful, providing a better quality of life and better renal functions than standard PCN in terminal malignancy patients.