晚期宫颈癌伴梗阻性肾功能衰竭患者输尿管置管失败后的治疗策略分析

Analysis of theraputic strategies of obstructive renal failure caused by advanced cervical cancer for patients failing to place the ureteral stent

目的探讨针对晚期宫颈癌继发双侧输尿管梗阻且输尿管置管失败患者的治疗策略。方法回顾性分析32例晚期宫颈癌继发双侧输尿管梗阻且输尿管置管失败患者的临床资料。患者分别通过血液透析(血液透析组)、经皮肾穿刺引流术(PCN组)、腹腔镜下双侧输尿管腹壁造口术(尿流改道组)治疗,比较治疗前后各组24 h尿量、肾功能、电解质恢复情况,以及生活质量(QOL)评分、进一步针对宫颈癌的治疗情况和2年生存率。结果治疗后1周,24 h尿量比较,尿流改道组尿量最多,PCN组其次,均多于血液透析组,差异有统计学意义(P<0.01);血清肌酐浓度比较,尿流改道组明显低于PCN组及血液透析组,差异有统计学意义(P<0.01);血钾浓度比较,3组间差异无统计学意义(P>0.05)。尿流改道组接受根治性放疗的比例及生存期均明显优于其他两组,差异有统计学意义(P<0.05)。2年生存率比较,尿流改道组优于血液透析组(P<0.05),但与PCN组的差异无统计学意义(P>0.05)。术后QOL评分比较,尿流改道组明显优于其他两组(P<0.05)。结论对于晚期宫颈癌继发双侧输尿管梗阻且输尿管置管失败的患者,应根据具体病情选择相应的治疗策略,有效地改善患者肾功能,同时为患者进一步接受晚期宫颈癌的综合治疗创造条件,延长患者生存期,提高患者生存质量。

Objective To explore the theraputic strategies for patients with bilateral ureteral obstruction caused by advanced cervical cancer who has failed to place the ureteral stent.Methods Clinical data of 32 patients with bilateral ureteral obstruction caused by advanced cervical cancer who had failed to place the ureteral stent was retrospectively analyzed.Patients were divided into three groups that underwent hemodialysis（hemodialysis group）,percutaneous nephrostomy（PCN group）,and laparoscopic cutaneous ureterostomy（urinary diversion group）,respectively.The 24 h urine volume,renal function,electrolyte,quality of life（QOL）,further treatment of cervical cancer,and 2 year survival rate of three groups before and after treatment were compared.Results The 24 h urine volume of urinary diversion group one week after treatment was the most,followed by PCN group,then the hemodialysis group.The differences were statistically significant（P〈0.01）.The serum creatinine level of urinary diversion group was remarkably lower than that of PCN group and hemodialysis group and the differences were statistically significant（P〈0.01）.The differences of blood potassium level among three groups were not statistically significant（P〉0.05）.The rate of undergoing radical radiotherapy and survival time of urinary diversion group were remarkably better than those of other groups and the differences were statistically significant（P〈0.05）.The two-year survival rate of urinary diversion group was better than that of hemodialysis group（P〈0.05）,while the difference of two-year survival rate between urinary diversion group and PCN group was not statistically significant（P〉0.05）.The postoperative QOL score of urinary diversion group was remarkably better than that of other two groups（P〈0.05）.Conclusion For patients with bilateral ureteral obstruction caused by advanced cervical cancer who has failed to place the ureteral stent,theraputic strategies should be chosen according to different conditions in order to effectively improve the renal function of patients,create conditions for further treatment of advanced cervical cancer,prolong the survival time of patients,and improve the quality of life.