D-J管在中晚期盆腔肿瘤所致输尿管梗阻、肾盂积水治疗中的应用

Application of double J tube in treatment of ureteral obstruction caused by advanced pelvic tumors

目的探讨中晚期盆腔肿瘤转移与浸润所致输尿管梗阻、肾盂积水的治疗方法及疗效。方法对61例盆腔肿瘤转移与浸润所致输尿管梗阻、肾盂积水患者,分别采用膀胱镜下逆行置管、输尿管镜下逆行置管、经皮肾镜顺行置管方式于梗阻输尿管内置入D-J管,对比置管前后肾盂积水及肾功能改善的情况,以及不同直观方式相关并发症出现情况。结果61例患者均成功置管,膀胱镜逆行置管37例,输尿管镜逆行置管17例,经皮肾镜顺行置管6例,单纯肾造瘘术1例(1.6%),其中逆行置管成功54例(双侧梗阻中以成功一侧统计),占比88.6%。与置管前比较,患者肾盂积水程度显著减轻、置管后肌酐及尿素氮水平均明显改善(P<0.05)。术后随访时间3~27个月,平均16个月,所有患者尿路感染、尿路刺激及血尿发生率差异无统计学意义(P>0.05),但行经皮肾穿刺造瘘术患者慢性疼痛发生率高于其他三种置管方式患者,差异有统计学意义(P<0.05)。结论输尿管内留置D-J管可有效解除中晚期盆腔肿瘤所致输尿管梗阻,减轻肾盂积水,改善肾脏功能,有效延长患者带瘤生存期,是解除盆腔肿瘤转移与浸润所致输尿管梗阻、肾盂积水首选的治疗方法,逆行置管方式与顺行置管相比操作更简单,在成功率、并发症方面更有优势。

Objective To investigate the treatment method and therapeutic effects on ureteral obstruction and hydronephrosis caused by metastasis and infiltration of pelvic tumors at middle and advanced stage.Methods A total of 61 patients with ureteral obstruction and hydronephrosis caused by pelvic tumor metastasis and infiltration were treated by retrograde catheterization under cystoscope,retrograde catheterization under ureteroscope and retrograde catheterization under percutaneous nephroscope.The improvement status of hydronephrosis and renal function before and after catheterization were observed and compared.Moreover the complications of patients were observed.Results The catheterization was performed successfully for all the patients,on whom,there were 37 cases of retrograde catheterization under cystoscope,17 cases of retrograde catheterization under ureteroscope,6 cases of retrograde catheterization under percutaneous nephroscope.and 1 case of simple nephrostomy.Of which,54 cases were performed successfully(the success of bilateral obstruction was counted on one side),accounting for 88.6%.As compared with that before catheterization,the degree of hydronephrosis was significantly relieved,creatinine and urea nitrogen levels were significantly improved after catheterization(P<0.05),and the treatment was effective.The follow-up time was 3~27 months(average 16 months).There was no significant difference in the incidence rate of urinary tract infection,urinary tract irritation and hematuria among all the patients(P>0.05),but the incidence of chronic pain in patients who underwent percutaneous nephrostomy was significantly higher than that in patients who underwent the other three kinds of catheterization approaches(P<0.05).Conclusion The double J tube indwelling in ureter can effectively relieve ureteral obstruction caused by middle or advanced pelvic tumors,relieve hydronephrosis,improve renal function and prolong the survival time of patients with pelvic tumors.It is the preferred treatment method to relieve ureteral obstruction and hydronephrosis caused by metastasis and infiltration of pelvic tumors.As compared with anterograde catheterization,retrograde catheterization is easier to operate and has more advantages in success rate and complications.