不同手术方法置入金属支架管治疗肿瘤性输尿管梗阻的疗效研究
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摘要
目的研究不同方法置入金属输尿管支架管治疗肿瘤性输尿管梗阻的经验及疗效。方法回顾性分析2014年6月-2018年4月该科收治的14例因腹、盆腔恶性肿瘤导致输尿管梗阻的患者资料,分别采用膀胱镜下置管术、输尿管镜下置管术、经皮肾镜顺行置管术以及膀胱切开输尿管置管术4种手术方式,术后随访观察疗效及并发症等情况。结果 14例患者均置管成功,术后肾积水均有不同程度缓解,术前、术后第7天肌酐值分别为(351.55±196.50)和(124.85±39.15)μmol/L,差异有统计学意义(P=0.014)。术后平均随访11个月,金属支架管平均留置时间为12个月,留置时间最长约2年,置管后未发生二次梗阻。死亡2例,12例存活至今,门诊复查未见支架管断裂、移位、失功和结石等,患者无明显异物感、无引流不畅,2例间断性出现肉眼血尿,1例术后反复尿路感染,另1例身体一般状况差,未能按时门诊复查。结论金属输尿管支架用于治疗肿瘤性输尿管梗阻安全有效,由于不同患者的手术情况不同,可灵活选择不同的置入方法。
Objective To study clinical experiences and outcomes of metallic ureteral stent with different method in treating the patients of malignant ureteral obstruction. Method The retrospective study enrolled 14 patients of abdominal or pelvic malignant tumor received metallic ureteral stent placement because of ureteral obstruction from Jun 2014 to Aug 2018. Its operation methods are listed as followed: metallic ureteral stent placement under cystoscope or ureteroscopy, nephroscope through anterograde approach, and bladder incision. Outcomes and complications were observed during follow-up. Results All the operations in this group were successful, the kidney seeper was improved. Respectively analyze the creatinine value before surgery and at day 7 after surgery was(351.55 ± 196.50) μmol/L,(124.85 ± 39.15) μmol/L, there is statistically signi?cant(P = 0.014). The mean follow-up was 11 months. The average retention time of metallic stent was about 12 months, and the longest was about 2 years.No secondary obstruction occurred after the operations, 2 cases died, 12 survived. The KUB showed that no fracture,displacement, loss of function and stone were found in the metallic stents to patients reviewed from outpatients,and they had no poor drainage, no obviously uncomfortable feeling. 2 cases occurred intermittent hematuria, and1 case occurred repeated urinary tract infections after operation. The other 1 case was in poor condition and were not reviewed on time. Conclusions Metallic ureteral stents are safe and effective for patients of malignant ureteral obstruction. Due to different operation conditions,different methods can be selected flexibly.
Objective To study clinical experiences and outcomes of metallic ureteral stent with different method in treating the patients of malignant ureteral obstruction. Method The retrospective study enrolled 14 patients of abdominal or pelvic malignant tumor received metallic ureteral stent placement because of ureteral obstruction from Jun 2014 to Aug 2018. Its operation methods are listed as followed: metallic ureteral stent placement under cystoscope or ureteroscopy, nephroscope through anterograde approach, and bladder incision. Outcomes and complications were observed during follow-up. Results All the operations in this group were successful, the kidney seeper was improved. Respectively analyze the creatinine value before surgery and at day 7 after surgery was(351.55 ± 196.50) μmol/L,(124.85 ± 39.15) μmol/L, there is statistically signi?cant(P = 0.014). The mean follow-up was 11 months. The average retention time of metallic stent was about 12 months, and the longest was about 2 years.No secondary obstruction occurred after the operations, 2 cases died, 12 survived. The KUB showed that no fracture,displacement, loss of function and stone were found in the metallic stents to patients reviewed from outpatients,and they had no poor drainage, no obviously uncomfortable feeling. 2 cases occurred intermittent hematuria, and1 case occurred repeated urinary tract infections after operation. The other 1 case was in poor condition and were not reviewed on time. Conclusions Metallic ureteral stents are safe and effective for patients of malignant ureteral obstruction. Due to different operation conditions,different methods can be selected flexibly.
引文
[1]ISHIOKA J,KAGEYAMA Y,INOUE M,et al.Prognostic model for predicting survival after palliative urinary diversion for ureteral obstruction:analysis of 140 cases[J].J Urol,2008,180(2):618-621.
[2]CHITALE S V,SCOTT-BARRETT S,HO E T,et al.The management of ureteric obstruction secondary to malignant pelvic disease[J].Clinical Radiology,2002,57(12):1118-1121.
[3]KULKARNI R.Metallic stents in the management of ureteric strictures[J].Indian J Urol,2014,30(1):65-72.
[4]CHOW P M,HSU J S,HUANG C Y,et al.Metallic ureteral stents in malignant ureteral obstruction:clinical factors predicting stent failure[J].J Endourol,2014,28(6):729-734.
[5]SAKAMOTO H,MATSUDA A,KANNO T,et al.Retrospective analysis of the Long-term indwelling ureteral stent[J].Hinyokika Kiyo,2012,58(6):269-272.
[6]CHRISTMAN M S,L’ESPERANCE J O,CHOE C H,et al.Analysis of urateral stent compression force and its role in maligant obstruction[J].J Urol,2009,181(1):392-396.
[7]KADLEC A O,ELLIMOOTTIL C S,GRECO K A,et al.Five-year experience with metallic stents for chronic ureteral obstruction[J].J Urol,2013,190(3):937-941.
[8]GOLDSMITH Z G,WANG A J,BA?EZ L L,et al.Outcomes of metallic stents for malignant ureteral obstruction[J].J Urol,2012,188(3):851-855.
[9]GAYED B A,MALLY A D,RILEY J,et al.Resonance metallic stents do not effectively relieve extrinsic ureteral compression in pediatric patients[J].J Endourol,2013,27(2):154-157.
[10]NAGELE U,KUCZYK M A,HORSTMANN M,et al.Initial clinical experience with full-length metal ureteral stents for obstructive ureteral stenosis[J].World J Urol,2008,26(3):257-262.
[11]POTRETZKE A M,CHANG H,KRYGER J V.Technique for Resonance?stent exchange in patients with extrinsic obstruction:description of a novel approach and literature review[J].J Pediatr Urol,2012,8(5):557-559.
[12]BORIN J F,MELAMUD O,CLAYMAN R V.Initial experience with full-length metal stent to relieve malignant ureteral obstruction[J].J Endourol,2006,20(5):300-304.
[13]MODI A P,RITCH C R,AREND D,et al.Multicenter experience with metallic ureteral stents for malignant and chronic benign ureteral obstruction[J].Journal of Urology,2010,24(7):1189-1193.
[14]ASAKAWA J,IGUCHI T,TAMADA S,et al.Outcomes of indwelling metallic stents for malignant extrinsic ureteral obstruction[J].Int J Urol,2018,25(3):258-262.
[15]KALLIDONIS P S,GEORGIOPOULOS I S,KYRIAZIS I D,et al.The full metallic double-pigtail ureteral stent:review of the clinical outcome and current status[J].Indian J Urol,2015,31(1):8-14.
[16]刘可,肖春雷,马潞林.金属输尿管支架置入治疗肿瘤性输尿管梗阻的疗效和初步经验[J].中华泌尿外科杂志,2015,36(10):757-760.[16]LIU K,XIAO C L,MA L L.The effectiveness of resonance metallic stents for alleviating malignant ureteral obstruction:outcomes and initial experiences[J].Chin J Urol,2015,36(10):757-760.Chinese
[17]FREDERICK L,ELLIMOOTTIL C,KADLEC A,et al.Cost analysis of metallic stents for chronic ureteral obstruction:a multicenter study[J].Urology Practice,2016,4(1):21-24.
[18]TAYLO R ER,BENSON A D,SCHWARTZ B F.Cost analysis of metallic ureteral stents with 12 months of follow-up[J].JEndourol,2012,26(7):917-921.
[19]LIATAIKOS E,KALLIDONIS P,KYRIAZIS I,et al.Ureteral obstruction:is the full metallic double-pigtail stent the way to go[J].Eur Urol,2010,57(3):480-486.
[2]CHITALE S V,SCOTT-BARRETT S,HO E T,et al.The management of ureteric obstruction secondary to malignant pelvic disease[J].Clinical Radiology,2002,57(12):1118-1121.
[3]KULKARNI R.Metallic stents in the management of ureteric strictures[J].Indian J Urol,2014,30(1):65-72.
[4]CHOW P M,HSU J S,HUANG C Y,et al.Metallic ureteral stents in malignant ureteral obstruction:clinical factors predicting stent failure[J].J Endourol,2014,28(6):729-734.
[5]SAKAMOTO H,MATSUDA A,KANNO T,et al.Retrospective analysis of the Long-term indwelling ureteral stent[J].Hinyokika Kiyo,2012,58(6):269-272.
[6]CHRISTMAN M S,L’ESPERANCE J O,CHOE C H,et al.Analysis of urateral stent compression force and its role in maligant obstruction[J].J Urol,2009,181(1):392-396.
[7]KADLEC A O,ELLIMOOTTIL C S,GRECO K A,et al.Five-year experience with metallic stents for chronic ureteral obstruction[J].J Urol,2013,190(3):937-941.
[8]GOLDSMITH Z G,WANG A J,BA?EZ L L,et al.Outcomes of metallic stents for malignant ureteral obstruction[J].J Urol,2012,188(3):851-855.
[9]GAYED B A,MALLY A D,RILEY J,et al.Resonance metallic stents do not effectively relieve extrinsic ureteral compression in pediatric patients[J].J Endourol,2013,27(2):154-157.
[10]NAGELE U,KUCZYK M A,HORSTMANN M,et al.Initial clinical experience with full-length metal ureteral stents for obstructive ureteral stenosis[J].World J Urol,2008,26(3):257-262.
[11]POTRETZKE A M,CHANG H,KRYGER J V.Technique for Resonance?stent exchange in patients with extrinsic obstruction:description of a novel approach and literature review[J].J Pediatr Urol,2012,8(5):557-559.
[12]BORIN J F,MELAMUD O,CLAYMAN R V.Initial experience with full-length metal stent to relieve malignant ureteral obstruction[J].J Endourol,2006,20(5):300-304.
[13]MODI A P,RITCH C R,AREND D,et al.Multicenter experience with metallic ureteral stents for malignant and chronic benign ureteral obstruction[J].Journal of Urology,2010,24(7):1189-1193.
[14]ASAKAWA J,IGUCHI T,TAMADA S,et al.Outcomes of indwelling metallic stents for malignant extrinsic ureteral obstruction[J].Int J Urol,2018,25(3):258-262.
[15]KALLIDONIS P S,GEORGIOPOULOS I S,KYRIAZIS I D,et al.The full metallic double-pigtail ureteral stent:review of the clinical outcome and current status[J].Indian J Urol,2015,31(1):8-14.
[16]刘可,肖春雷,马潞林.金属输尿管支架置入治疗肿瘤性输尿管梗阻的疗效和初步经验[J].中华泌尿外科杂志,2015,36(10):757-760.[16]LIU K,XIAO C L,MA L L.The effectiveness of resonance metallic stents for alleviating malignant ureteral obstruction:outcomes and initial experiences[J].Chin J Urol,2015,36(10):757-760.Chinese
[17]FREDERICK L,ELLIMOOTTIL C,KADLEC A,et al.Cost analysis of metallic stents for chronic ureteral obstruction:a multicenter study[J].Urology Practice,2016,4(1):21-24.
[18]TAYLO R ER,BENSON A D,SCHWARTZ B F.Cost analysis of metallic ureteral stents with 12 months of follow-up[J].JEndourol,2012,26(7):917-921.
[19]LIATAIKOS E,KALLIDONIS P,KYRIAZIS I,et al.Ureteral obstruction:is the full metallic double-pigtail stent the way to go[J].Eur Urol,2010,57(3):480-486.
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