上海交通大学学报（医学版）

上海交通大学学报（医学版）

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晚期宫颈癌伴梗阻性肾功能衰竭患者输尿管置管失败后的治疗策略分析

蒋晨1,3，钟一村2，4*，傅琦博1,3，吕坚伟1,3，李震东1,3，邱丰1,3，刘伟2,4，王育2,4   

  1. 上海交通大学 医学院 附属仁济医院南院 1.泌尿外科， 2. 妇产科， 上海201112； 附属仁济医院 3.泌尿外科， 4.妇产科， 上海 200127
  • 出版日期:2015-12-28 发布日期:2016-01-21
  • 通讯作者: 王育, 电子信箱: renjiwangyu@126.com。
  • 作者简介:蒋晨（1981—）， 男， 主治医师， 硕士; 电子信箱: jiang_chen123@126.com。*为并列第一作者。

Analysis of theraputic strategies of obstructive renal failure caused by advanced cervical cancer for patients failing to place the ureteral stent

JIANG Chen1,3, ZHONG Yi-cun2,4*, FU Qi-bo1,3, LV Jian-wei1,3, LI Zhen-dong1,3, QIU Feng1,3, LIU Wei2,4, WANG Yu2,4   

  1. 1.Department of Urology， 2.Department of Gynecology， Renji Hospital South Campus， Shanghai Jiao Tong University School of Medicine， Shanghai 201112， China； 3.Department of Urology， 4.Department of Gynecology， Renji Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200127， China
  • Online:2015-12-28 Published:2016-01-21

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摘要：

目的  探讨针对晚期宫颈癌继发双侧输尿管梗阻且输尿管置管失败患者的治疗策略。方法  回顾性分析32例晚期宫颈癌继发双侧输尿管梗阻且输尿管置管失败患者的临床资料。患者分别通过血液透析（血液透析组）、经皮肾穿刺引流术（PCN组）、腹腔镜下双侧输尿管腹壁造口术(尿流改道组)治疗，比较治疗前后各组24 h尿量、肾功能、电解质恢复情况，以及生活质量（QOL）评分、进一步针对宫颈癌的治疗情况和2年生存率。结果  治疗后1周，24 h尿量比较，尿流改道组尿量最多，PCN组其次，均多于血液透析组，差异有统计学意义（P<0.01）；血清肌酐浓度比较，尿流改道组明显低于PCN组及血液透析组，差异有统计学意义（P<0.01）；血钾浓度比较，3组间差异无统计学意义（P>0.05）。尿流改道组接受根治性放疗的比例及生存期均明显优于其他两组，差异有统计学意义（P<0.05）。2年生存率比较，尿流改道组优于血液透析组(P<0.05)，但与PCN组的差异无统计学意义（P>0.05）。术后QOL评分比较，尿流改道组明显优于其他两组（P<0.05）。结论   对于晚期宫颈癌继发双侧输尿管梗阻且输尿管置管失败的患者，应根据具体病情选择相应的治疗策略，有效地改善患者肾功能，同时为患者进一步接受晚期宫颈癌的综合治疗创造条件，延长患者生存期，提高患者生存质量。

关键词: 晚期宫颈癌, 输尿管梗阻, 肾功能不全, 腹腔镜下输尿管腹壁造口术, 经皮肾穿刺引流术, 血液透析, 预后

Abstract:

Objective  To explore the theraputic strategies for patients with bilateral ureteral obstruction caused by advanced cervical cancer who has failed to place the ureteral stent. Methods  Clinical data of 32 patients with bilateral ureteral obstruction caused by advanced cervical cancer who had failed to place the ureteral stent was retrospectively analyzed. Patients were divided into three groups that underwent hemodialysis (hemodialysis group), percutaneous nephrostomy (PCN group), and laparoscopic cutaneous ureterostomy (urinary diversion group), respectively. The 24 h urine volume, renal function, electrolyte, quality of life (QOL), further treatment of cervical cancer, and 2 year survival rate of three groups before and after treatment were compared. Results  The 24 h urine volume of urinary diversion group one week after treatment was the most, followed by PCN group, then the hemodialysis group. The differences were statistically significant (P<0.01). The serum creatinine level of urinary diversion group was remarkably lower than that of PCN group and hemodialysis group and the differences were statistically significant (P<0.01). The differences of blood potassium level among three groups were not statistically significant (P>0.05). The rate of undergoing radical radiotherapy and survival time of urinary diversion group were remarkably better than those of other groups and the differences were statistically significant (P<0.05). The two-year survival rate of urinary diversion group was better than that of hemodialysis group (P<0.05), while the difference of two-year survival rate between urinary diversion group and PCN group was not statistically significant (P>0.05). The postoperative QOL score of urinary diversion group was remarkably better than that of other two groups (P<0.05). Conclusion  For patients with bilateral ureteral obstruction caused by advanced cervical cancer who has failed to place the ureteral stent, theraputic strategies should be chosen according to different conditions in order to effectively improve the renal function of patients, create conditions for further treatment of advanced cervical cancer, prolong the survival time of patients, and improve the quality of life.

Key words: advanced cervical cancer, ureteric obstruction, renal dysfunction, hemodialysis, percutaneous nephrostomy, laparoscopic cutaneous ureterostomy, prognosis