晚期宫颈癌并发双侧输尿管梗阻40例治疗预后分析  

Prognostic factors and treatment of bilateral ureteral obstruction caused by advanced cervical cancer

作　　者：程淑霞 成慧君 王莉 

机构地区：[1]郑州大学附属肿瘤医院妇瘤科,郑州市450003

出　　处：《中国肿瘤临床》2013年第15期923-925,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:分析晚期宫颈癌并发双侧输尿管梗阻的预后因素,探讨其治疗意义。方法:通过肾图、CT、肾功能检查诊断晚期宫颈癌并发双侧输尿管梗阻患者40例,膀胱镜下输尿管逆行置管内引流13例,经皮肾穿刺输尿管顺行置管内引流25例、外引流2例,肾功能恢复正常后行放射治疗29例,对比研究输尿管导管置入前是否接受过治疗、肾功能是否正常,置管后是否接受放疗三种因素对预后的影响。结果:输尿管导管置入后肾功能恢复正常率为91.3%(21/23)。未治疗组、术后和放疗后复发组中位生存时间分别为27、15、10个月(χ2=9.379,P=0.009)。置管后接受放疗组与未行放疗组中位生存时间分别为25、9个月(χ2=17.329,P<0.001),置管前肾功能是否正常对预后影响无显著性差异(χ2=1.37,P=0.242)。结论:对于初治或术后复发的宫颈癌并发双侧输尿管梗阻患者,在解除输尿管梗阻后,应接受放射治疗,可获得较好疗效。Objective： This study aimed to analyze the prognostic factor of bilateral hydronephrosis caused by advanced cervical cancer and evaluate its value of treatment. Methods： A total of 40 patients with bilateral ureteral obstruction secondary to cervical cancer were diagnosed through computerized tomography, radioactive nephrogram, and blood tests for renal function. The placement of retrograde internal double-J ureteral stents was performed under a cystoscope in 13 patients. The placement of antegrade internal double-J ureteral stents via percutaneous nephrostomy was performed in 25 patients. Two cases had external ureteral stents via percutaneous nephrostomy. Twenty-nine patients underwent radiotherapy after normalization of their blood urine nitrogen and creatinine levels. The prognostic value of the treatment and renal function before placement of ureteral stents and radiotherapy after placement of ureteral stents were analyzed. Results： The normalization rate of renal function after ureteral stenting was 91.3% （21/23）. The median survival time was longer in patients with untreated cervical cancer than that in patients with recurrent cervical cancer （χ^2=9.379, P=-0.009）. After ureteral stenting, the median survival time was longer in patients who underwent radiation therapy than that in patients untreated with radiation （χ^2=17.329, P=0.000）. The median survival time was not significantly influenced by renal function before placement of ureteral stents （χ^2=1.37, P=-0.242）. Conclusion： The patient with bilateral ureteral obstruction from untreated cervical cancer or from recurrent pelvic disease after surgical therapy should be considered for ureteral stenting followed by appropriate radiation.

关 键 词：宫颈癌 输尿管梗阻 输尿管置管 放射治疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]