盆腔恶性肿瘤术后输尿管下段梗阻的腔镜手术治疗(英文)  

Endourologic Treatments of Distal Ureteral Obstruction in Patients with History of Pelvic Malignancies:Efficacy and Safety Evaluation

作　　者：温星桥[1] 高新[1] 张勇[2] 蔡育彬[1] 邱剑光[1] 司徒杰[1] 湛海伦[1] 王德娟[1] 

机构地区：[1]中山大学附属第三医院泌尿外科,广东广州510630 [2]中山大学附属第三医院核医学科,广东广州510630

出　　处：《癌症》2007年第11期1227-1230,共4页Chinese Journal of Cancer

摘　　要：背景与目的:盆腔恶性肿瘤手术后组织粘连、瘢痕形成或放射治疗等常导致输尿管下段受压梗阻及肾积水。本研究旨在评价利用腔镜技术治疗此类输尿管梗阻的疗效与安全性。方法:1998年1月至2007年3月,46例有输尿管下段梗阻伴盆腔肿瘤史的患者在中山大学附属第三医院接受了腔镜手术,分析围手术期及随访资料。结果:46例患者中,25例行腹腔镜输尿管-膀胱吻合术,18例行输尿管镜放置支架管引流,3例行经皮肾造瘘术,未发生严重并发症。平均手术时间82.5min(30～140min),术中出血45.5ml(5～180ml),均未接受输血。中位随访时间18.2个月(3个月～6.5年)。术后3个月,静脉尿路造影及B超提示39例(84.8%)肾分泌恢复正常,其余7例(15.2%)肾积水减轻、肾功能改善;核素扫描提示平均患侧肾小球滤过率比术前升高(37.6ml/minvs.21.3ml/min,P<0.05)。所有输尿管-膀胱吻合口无狭窄。结论:腔镜手术治疗部分类型盆腔肿瘤手术后或放疗后下段输尿管梗阻是有效、可行的。BACKGROUND ＆ OBJECTIVE： Postoperative tissue adherence, scarring and radiotherapy often lead to extrinsic compression and stricture in the distal ureter of the patients who had history of pelvic malignancies. Our aim was to evaluate the efficacy and safety of endourologic techniques in treating this kind of ureteral obstruction. METHODS： From Jan. 1998 to Mar. 2007, 46 patients with obstruction in the distal ureter and had history of pelvic malignancies underwent endoscopic treatments at the Third Affiliated Hospital of Sun Yat-sen University for relief of the obstruction. Perioperative and follow-up data were analyzed. RESULTS： Of the 46 patients, 25 underwent laparoscopic ureterolysis and ureteroneocystostomy, 18 underwent placement of ureter stent under ureteroscope, 3 underwent percutaneous nephrostomy. No severe complication was recorded. The mean operating time was 82.5 min （range, 30-140 min）. The mean blood loss was 45.5 ml （range, 5-180 ml）. No blood transfusion was needed. The median follow-up time was 18.2 months （range, 3 months to 6.5 years）. Three months after operation, B-ultrasonography and intravenous urography （IVU） showed that 39 （84.8%） patients had recovered normal renal function, the other 7 （15.2%） had hydronephrosis relief and renal function improvement. Nuclear renal scanning showed that the mean postoperative glomerular filtration rate （GFR） in the obstructive kidney was higher than the preoperative level （37.6 ml/min vs. 21.3 ml/min, P〈0.05）. No stricture in the uretero-bladder anastomotic stoma was recorded. CONCLUSION： Endoscopic operation is an effective and feasible option for managing some selected kinds of distal ureteral obstruction caused by postoperative tissue adherence and radiotherapy in the patients with history of pelvic malignancies.

关 键 词：腹腔镜 输尿管镜 输尿管梗阻/并发症 外科手术 盆腔肿瘤 

分 类 号：R730.5[医药卫生—肿瘤]