摘要
目的:探讨宫颈癌相关的上尿路梗阻的处理。方法:选取2002年5月～2003年9月就诊的35例因宫颈癌导致的输尿管梗阻患者,17例为初诊病例,18例为复诊病例,其中13例肿瘤复发,5例无肿瘤复发依据。35例中27例双侧肾盂积水,8例单侧积水。18例复诊和5例初诊患者在膀胱镜下试行放置双J管,分别有6例和4例成功置入,另12例复诊患者中3例接受双侧输尿管皮肤造口术,4例接受单侧经皮肾盂穿刺造瘘术,余5例未处理积水;另13例初诊患者术中放置双J管。结果:5例未处理积水的患者均于2个月内死亡。23例留置双J管的患者,积水均在置管后不同程度地改善,其中4例分别于4、5、7、9个月后死于肿瘤广泛转移;10例成功换管,2例无法逆行换管,余7例术后未满6个月,尚未更换双J管。所有行膀胱镜操作的23例患者中,3例发生尿路感染。7例外引流患者随访已达1～9个月,积水均有改善。4例肾盂穿刺的患者均在术后发生引流管堵塞,1例发生引流管脱落,无操作相关性死亡。结论:对于因宫颈癌导致的上尿路梗阻患者,首选膀胱镜下逆行置管,恶性狭窄须双侧置管,若失败,再根据不同原因和不同病情,制定合适的治疗方案。
Objective: To investigate the proper treatment of upper urinary tract obstruction due to cervical cancer. Methods: 35 cases with upper urinary tract obstruction due to cervical cancer treated 2002.5～2003.9 were included: 17 advanced cancer without previous treatment; 5 without the evidence of tumor but treated with chemotherapy or radiotherapy previously; 13 recurrent tumor, 27 patients had hydronephrosis bilaterally. Endoscopic internal stent drainage was tried for 5 initial cases and 18 previously treated patients, 4 and 6 were successful respectively. Among the other 12 previously treated patients, 3 received bilateral ureterostomsis, 4 received unilateral transcutaneous nephrostomy and the rest received no further treatment. Otherwise, the other 13 with primary locally advanced cancer received operative retroperitoneal ureteral catheterization. Results: All the 5 patients without further treatment died within 2 months, while the nephrohydrosis of the 23 cases with catheterization improved, among them, 4 died of cancer progression, 10 had changed the stents successfully, 2 failed to change the stents, the others were just in follow-up and it was not the timing to change stents.3 of the 23 cases treated with endoscopy developed infection. Among the 7 received external drainage (follow-up, 1~9 months), 4 nephrostomic tubes were jamed and 1 tube dislodged, no treatments associated death occurred. Conclusions: Endoscopic internal stent drainage was the choice treatment for the patients with upper urinary tract obstruction due to cervical cancer,if failed,should treat properly according to the different cause of obstruction and patients' different condition.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2004年第12期690-692,共3页
Chinese Journal of Clinical Oncology
关键词
肾积水
宫颈癌
输屎管支架
处理方法
cervical cancer nephrohydrosis ureteral stent treatmen
