摘要
目的评价输尿管支架置入术(IUS)及经皮肾穿刺造瘘(PCN)治疗对恶性输尿管梗阻肾功能不全患者肾功能改善以及对生活质量的影响,探讨其适应证的选择。方法回顺分析75例恶性输尿管梗阻致肾积水肾功能不全患者治疗经过,分别采用逆行输尿管支架置入术、顺行输尿管支架置入术、经皮肾穿刺造瘘术。于治疗前、治疗后检查肌酐、尿素、肾盂分离、生活质量变化,总结PCN及IUS适应证的选择。结果治疗后肾盂分离、肌酐、尿素分别由(2.76±1.25)cm、(377±236)mmol/L、(19.1±8.4)mmol/L下降至(1.32±0.60)cm(P<0.01)、(149±106)mmol/L(P<0.01)、(12.9±6.6)mmol/L(P<0.01);生活质量评分分别南86.2±9.8下降至84.4±9.2(P<0.01)。结论 IUS和PCN对于恶性输尿管梗阻引起的肾积水、肾功能不全、生活质量下降均有改善作用,需根据患者身体状况及意愿等选择不同的引流方式。
Objective To assess the clinical efficacy of urinary internal ureteral stenting （IUS） and percutaneous nephrostomy （PCN） in the management of malignant ureteral obstruction complicated by renal insufficiency, to analyze its impact on the patient＇s quality of life, and to discuss the indications of IUS and PCN. Methods A total of 75 patients with malignant ureteral obstruction accompanied with renal insufficiency were enrolled in this study. The clinical data were retrospectively analyzed. Retrograde IUS, or anterograde IUS or PCN was carried out in each patient. The pelvis separation, creatinine and urea nitrogen levels were determined before and after the treatment. Observation of the postoperative changes in patient＇s quality of life was conducted. Reasonable selection of the indications was analyzed. Results After the treatment the pelvis separation, creatinine and urea nitrogen decreases from preoperative （2.76 ± 1.25）cm, （377 ± 236）umol/L and （19.1 ± 8.4）mmol/L respectively to postoperative（1.32 ± 0.60）cm （P 〈 0.01）, （149 ± 106）umol/L（P 〈 0.01） and（12.9 ± 6.6） mmol/L （P 〈 0.01 ） respectively. The score of life quality decreases form preoperative 86.2 ± 9.8 to posto-perative 84.4 ± 9.2 （P 〈 0.01 ）. Conclusion IUS and PCN can improve the severity of hydronephrosis and renal insufficiency as well as the worsen living quality caused by malignant ureteral obstruction. The pyelic drainage pattern should be selected according to the clinical condition and the patient＇s own will. （J Intervent Radio1, 2012, 21： 776-779）
出处
《介入放射学杂志》
CSCD
北大核心
2012年第9期776-779,共4页
Journal of Interventional Radiology
关键词
恶性输尿管梗阻
肾功能不全
肾穿刺造瘘
输尿管支架
malignant ureteral obstruction
renal insufficiency
percutaneous nephrostomy
internal ureteral stenting
