不同手术方法治疗恶性输尿管梗阻临床效果比较

Comparison of effect of different technique in treating maleatignant ureteral obstruction

目的比较3种手术方法治疗恶性输尿管梗阻的临床效果。方法回顾性分析35例恶性输尿管梗阻患者的临床资料,其中19例患者行局部麻醉下B超引导微创经皮肾穿刺造瘘术(肾穿刺造瘘组),12例采用输尿管镜下放置双J管(双J管组),4例行输尿管皮肤造口术(皮肤造口组),比较3组患者的手术时间、术中出血量及术后3、7 d和1个月肾功能恢复情况。结果双J管组患者的手术时间、术中出血量及术后住院时间显著少于肾穿刺造瘘组和皮肤造口组(P<0.05);皮肤造口组患者的手术时间、术中出血量及术后住院时间显著高于肾穿刺造瘘组(P<0.05)。双J管组和皮肤造口组患者术后3、7 d的血肌酐水平显著高于肾穿刺造瘘组(P<0.05);皮肤造口组患者术后3、7 d血肌酐水平与双J管组比较差异无统计学意义(P>0.05)。3组患者术后1个月血肌酐水平及术后肾功能恢复时间比较差异均无统计学意义(P>0.05)。结论对于恶性肿瘤所致输尿管梗阻导致肾功能不全的患者,B超引导下局部麻醉微创经皮肾穿刺造瘘术能迅速有效地引流尿液,缓解上尿路梗阻,及时挽救肾功能。

Objective To compare the clinical effect of three different treatment methods in treating malignant ureteral obstruction. Methods The clinical therapy of 35 patients with malignant ureteral obstruction were retrospectively analyzed. Among the patients, 19 cases underwent ultrasound guided minimally invasive percutaneous renal puncture fistulization under local anesthesia（ puncture fistulization group） , 12 patients were placed double J tube under ureteroscope （double J tube group） , 4 cases were given ureterocutaneostomy（ ureterocutaneostomy group）. Operation time, amount of bleeding during operation, renal functional rehabilitation at 3 days ,7 days, one month after operation among the three groups were compared. Results The operation time, amount of bleeding during operation, and postoperative hospital stay of double J tube group were significantly lower than those of puncture fistulization group and ureterocutaneostomy group （ P 〈 0.05 ）, but the operation time, amount of bleeding during operation, and postoperative hospital stay of ureterocutaneostomy group was significantly higher than that of puncture fistulization group （ P 〈 0.05 ）. The level of serum creatinine in double J tube group and ureterocutaneostomy group at 3 days and 7 days after operation was significantly higher than that in puncture fistulization group （ P 〈 0. 05 ）. There was no statistical significance in the level of serum creatinine between double J tube group and ureterocutaneostomy group at 3 days and 7 days after operation（ P 〉 0.05 ）. There was no statistical significance in the level of serum creatinine and renal functional rehabilitation time at one month after operation among the three group （ P 〉 0.05 ）. Conclusion For patients with renal insufficiency who are caused by malignant tumor leaded to ureteral obstruction, ultrasound guided minimally invasive percutaneous renal puncture fistulization under local anesthesi could drain urine effectively, solve upper urinary tract obstruction, timely save kidney function.