腹膜后肿瘤术后尿瘘的危险因素分析  

Analysis of risk factors for urinary fistula after retroperitoneal tumors resection

作　　者：张展志[1] 于军辉[1] 刘刚[1] 廖代祥[1] 罗成华[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院普外三区,北京100038

出　　处：《中华肿瘤防治杂志》2015年第6期463-466,473,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：北京市科委首都市民健康项目培育(Z11110706730000;Z111107067311063)

摘　　要：目的 分析腹膜后肿瘤术后发生尿瘘的危险因素并总结尿瘘的处理经验.方法 回顾性分析2009-04-2014-04首都医科大学附属北京世纪坛医院普通外科行腹膜后肿瘤手术的530例患者,术后随访2～6个月,期间发生尿瘘29例,对其危险因素进行Logistic多因素分析,进而总结预防和处理尿瘘并发症的经验.结果 530例患者中有29例发生尿瘘,其中输尿管瘘25例,膀胱瘘4例,经Logistic回归分析发现,发生尿瘘并发症的相关因素中术区放疗史是最大的危险因素（OR=80.973）,其次是肿瘤最大直径（OR=58.258）;术前血白蛋白水平（OR=0.021）是最大的保护因素,其次是输尿管支架置入术（OR=0.054）.25例输尿管瘘患者均先行超声引导下肾盂造瘘术,充分转流尿液.有5例经肾盂造瘘引流术后自愈,2例引流随访期间肿瘤复发死亡,8例输尿管瘘再行经皮下隧道肾盂膀胱导管引流术后治愈,其余10例输尿管瘘患者接受再次开腹部手术治疗后愈合.4例膀胱瘘患者行留置尿管及膀胱冲洗治疗,其中3例自行愈合,1例再行膀胱造瘘术后自行愈合.结论 腹膜后肿瘤手术患者,因术区放疗史、肿瘤较大、术前血白蛋白水平低和未放置输尿管支架者,易发生尿瘘;发生尿瘘患者经肾盂造瘘、膀胱造瘘、留置尿管以及皮下隧道肾孟膀胱导管引流术和开腹手术,均可获得治愈.OBJECTIVE To analyse the risk factors of urinary fistula after retroperitoneal tumor resection and sum- marize the treatment experience of urinary fistula. METHODS A retrospective analysis of 530 cases of retroperitoneal tumor surgery,which had 29 cases urinary fistula, was performed in general surgery of our hospital between April 2009 and April 2014 in Hospital of Beijing Shijitan, with a follow up period of 2--6 months. A Logistic analysis of multiple fac- tors of urinary fistula was performed,and then sum up the experiences of the prevention and treatment of the urinary fis- tula complication. RESULTS Among the 29 cases of urinary fistula,there were 25 cases of ureteral fistula and 4 cases of bladder fistula. Among the urinary fistula related factors, operative region radiotherapy history was the biggest risk factors （OR=80. 973） ,followed by tumor diameter （OR=58. 258）. Blood albumin level was the biggest protection factor （OR= 0. 021）, followed by the ureteral stent implantation （OR= 0. 054）. All 25 patients with ureteral fistula received ultrasound guided percutaneous renal pelvis colostomy firstly,and the flow of urine was transferred. Five cases were self-healed after the renal pelvis colostomy drainage, 2 cases with drainage died from tumor recurrence during the follow-up period,8 cases of ureteral fistula were cured by renal pelvis-bladder catheter drainage through the subcutaneous tunnel, the remaining 10 cases of ureteral fistula patients accepted open abdominal surgery finally and healed after treatment. Four cases of blad- der fistula patients received indwelling ureter and bladder irrigation treatment, including 3 cases of self healing, 1 case healed after bladder eolostomy. CONCLUSIONS Patients who received retroperitoneai tumor surgery,with the history of radiotherapy,with larger tumor,whose preoperative blood albumin level is low, and without ureteral stent placement, are prone to develop urinary fistula. In the event of urinary fistula,it can be cured by renal pelvis colostomy,

关 键 词：腹膜后肿瘤 尿瘘 危险因素 回顾性分析 

分 类 号：R735.4[医药卫生—肿瘤]