不同引流方式治疗恶性输尿管梗阻疗效及并发症分析

Analysis of curative effect and complication of different drainage methods for malignant ureteral obstruction

目的 比较逆行性输尿管支架置入术(RUS)与经皮肾穿刺造瘘术(PCN)解除恶性输尿管梗阻(MUO)的临床疗效及并发症。方法 回顾性分析我院2018年9月~2021年10月49例恶性肿瘤合并肾积水患者临床资料,统计并分析一般资料:年龄、性别、恶性肿瘤类型、原发肿瘤治疗方式、腹膜后淋巴结是否存在转移、肿瘤是否存在、引流方式等;评估引流效果:肾积水变化、肾功能是否好转、下肢水肿是否消退;观察并发症:引流失效、尿培养阳性、上尿路感染所致发热、血尿、尿白细胞升高。结果 两种引流方式在改善肾功能、减轻下肢水肿方面均取得较好的效果;两组术后肉眼血尿、尿路感染、发热发生率差异均无统计学意义(P>0.05);但PCN组肾积水改善率(74.2%)优于RUS组(44.4%),RUS组较PCN组更容易出现引流失效,差异具有统计学意义(P<0.05)。结论 两种引流方式对改善肾功能、肾积水,减轻下肢水肿均能取得良好效果;但随着病程的进展,RUS更容易出现引流失效,PCN是解除梗阻的更佳方法。

Objective To compare the curative effect and complication of retrograde ureteral stenting(RUS) and percutaneous nephrostomy(PCN) in the treatment of malignant ureteral obstruction(MUO). Methods The clinical data of 49 patients with malignant tumor combined with hydronephrosis from Sep 2018 to Oct 2021 in our hospital were retrospectively analyzed, and the general data were counted and analyzed: age, gender, type of malignant tumor,treatment method of primary tumor, presence of metastasis of retroperitoneal lymph node, presence of tumor, and drainage method of hydronephrosis. Evaluated drainage effect: change of hydronephrosis, improvement of renal function,and resolution of edema in the lower limbs. Observed complications including drainage failure, positive urine culture,fever caused by upper urinary tract infection, hematuria and hyperleukocytosis. Results The two drainage methods all had good results in improving renal function and reducing edema of the lower limbs. There was no significant difference in the incidence of hematuria, urinary tract infection and fever between the two groups(P>0.05). But the improvement rate of hydronephrosis in the PCN group(74.2%) was better than that in the RUS group(44.4%). The RUS group was more prone to drainage failure than the PCN group, and the difference was statistically significant(P<0.05). Conclusion The two drainage methods can achieve good drainage effects in improving renal function,hydronephrosis and reducing edema of the lower limbs. PCN can be used to relieve obstruction due to RUS is more prone to drainage failure during the progress of the disease.