宫颈癌合并输尿管梗阻引起肾积水患者行改良输尿管支架置换术的疗效观察

Observation on efficacy of modified ureteral stent replacement in patients with cervical cancer combined with hydronephrosis due to ureteral obstruction

目的观察宫颈癌合并输尿管梗阻引起肾积水患者行改良输尿管支架置换术的疗效。方法131例宫颈癌合并输尿管梗阻引起肾积水患者,随机分为改良手术组(43例)及传统手术组(88例)。改良手术组行改良输尿管支架置换术,传统手术组行传统输尿管支架置换术。比较两组患者的初始组间特征;采用一对一倾向评分匹配方案减少两组随机化偏倚,倾向评分匹配后改良手术组及传统手术组各43例,比较倾向评分匹配后两组患者的特征;比较倾向评分匹配前后置换成功率,观察倾向评分匹配后置换失败处理结果。结果两组患者初始体质量指数(BMI)、国际妇产科联盟(FIGO)分期、输尿管梗阻程度、放射治疗、已进行更换支架次数、治疗前肌酐水平比较,差异具有统计学意义(P<0.05)。倾向评分匹配后,改良手术组的手术时间(14.84±7.31)min短于传统手术组的(20.58±8.90)min,肉眼血尿持续时间≤2 d占比86.0%及置换成功率95.3%高于传统手术组的62.8%、69.8%,差异具有统计学意义(P<0.05)。倾向评分匹配前后,改良手术组患者的置换成功率均为95.3%,均高于传统手术组的75.0%、69.8%,差异具有统计学意义(P<0.05)。传统手术组倾向评分匹配后置换失败13例,6例行经皮肾造口,3例行输尿管造口,4例未治疗。改良手术组倾向评分匹配后置换失败2例,1例行经皮肾造口,1例未治疗。结论改良输尿管支架置换术是宫颈癌合并输尿管梗阻引起肾积水患者的一种先进治疗方法。改良手术缩短了手术时间,提高了手术的成功率并减少了持续肉眼血尿的时间,是一种值得推广的方法。

Objective To observe the efficacy of modified ureteral stent replacement in patients with cervical cancer combined with hydronephrosis due to ureteral obstruction.Methods A total of 131 patients with cervical cancer and hydronephrosis due to ureteral obstruction were randomly divided into modified surgery group(43 cases)and conventional surgery group(88 cases).The modified surgery group was treated with modified ureteral stent replacement,and the conventional surgery group was treated with conventional ureteral stent replacement.The initial characteristics of the two groups were compared;and one-to-one propensity score matching was used to reduce randomization bias of the two surgical methods,with 43 patients in each of the modified surgery group and the conventional surgery group;the characteristics of patients in the two groups after propensity score matching were compared.The success rate of replacement before and after propensity score matching were compared,and the treatment results of replacement failure after propensity score matching were observed.Results There were statistically significant differences between the two groups in terms of initial body mass index(BMI),International Federation of Gynecology and Obstetrics(FIGO)staging,degree of ureteral obstruction,radiotherapy,number of stent replacements,and creatinine level before treatment(P<0.05).After propensity score matching,the operation time(14.84±7.31)min of the modified surgery group was shorter than(20.58±8.90)min of the conventional surgery group;the proportion of duration of gross hematuria≤2 d of the modified surgery group was 86.0%and the replacement success rate was 95.3%,which were higher than 62.8%and 69.8%of the conventional surgery group.The differences were statistically significant(P<0.05).Before and after propensity score matching,the success rate of replacement in the improved surgery group was 95.3%and 95.3%,which was higher than 75.0%and 69.8%in the conventional surgery group,and the differences were statistically significant(P<0.05).In the conventional surgery group,there were 13 cases of replacement failure after propensity score matching,of which 6 cases had percutaneous nephrostomy,3 cases had ureterostomy,and 4 cases were untreated;in the modified surgery group,there were 2 cases of replacement failure after propensity score matching,of which 1 case had percutaneous nephrostomy and 1 case was untreated.Conclusion Modified ureteral stent replacement therapy is an advanced treatment for cervical cancer patients with cervical cancer and hydronephrosis due to ureteral obstruction.The modified method can shorten the operation time,improve the success rate and reduce the time of persistent gross hematuria.It's a method worth popularizing.