宫颈癌放疗合并梗阻性肾病的处理策略  

Treatment of obstructive nephropathy in the course of radiotherapy for cervical cancer

作　　者：杨春华[1] 王侠[1] 章龙珍[1] 唐天友[1] 姚元虎[1] 刘桂红[1] 

机构地区：[1]徐州医学院附属医院放射治疗科,江苏徐州221002

出　　处：《中国校医》2016年第11期859-860,862,共3页Chinese Journal of School Doctor

基　　金：徐州市科技局自然基金(KC14SH111)

摘　　要：目的探讨宫颈癌放疗合并梗阻性肾病的处理策略。方法分析2008年5月—2014年5月就诊的58例宫颈癌放疗合并梗阻性肾病患者的临床资料,其中28例双J管置入、12例超声引导肾穿刺引流、8例经皮肾镜造瘘、2例输尿管皮肤造瘘、5例行血液透析、3例患者拒绝治疗,比较各种治疗方法的满意度、并发症发生率及放疗完成率。结果采取治疗措施的55例患者梗阻症状、肾积水及肾功能1周后均不同程度的改善,有效率100.0%。双J管置入、超声引导肾穿刺引流、经皮肾镜造瘘、输尿管皮肤造瘘、血液透析的相关并发症发生率17.9%、25.0%、37.5%、100.0%、60.0%,满意度依次为82.1%、66.7%、62.5%、50.0%、60.0%,放疗完成率依次为89.3%、83.3%、75.0%、50.0%,无操作相关性死亡。3例未处理患者均于2个月内死亡。结论双J管置入、超声引导肾穿刺引流、经皮肾镜造瘘、输尿管皮肤造瘘、血液透析均是宫颈癌放疗合并梗阻性肾病的有效处理方法。双J管置入并发症发生率低、满意度高、对放疗影响小,可作为首选。Objective To explore the proper treatment of obstructive nephropathy in the course of radiotherapy for cervical cancer. Methods A total of 58 cases of obstructive nephropathy in the course of radiotherapy for cervical cancer from 2008.5-2014.5 were included： 28 cases were inserted double J stent, 12 cases were treated with ultrasound guided renal puncture and drainage, 8 cases were treated with percutaneous renal fistula, 2 cases were treated with ureteral fistula, 5 cases were treated with hemodialysis, and the rest （3 cases） refused further treatments.All the clinical data were collected and analyzed, and the complication rate, satisfaction and radiotherapy completion rate were compared among the different treatment methods. Results All the 55 patients who received the further treatment had improvement in different degreesin obstructive symptoms, uronephrosis and renal function, and the total effect rate was 100%. The complication rate, satisfaction, and radiotherapy completion rate of the inserting double J stent, ultrasound guided renal puncture and drainage, percutaneous renal fistula, ureteral fistula and hemodialysis were 17.9%, 25.0%, 37.5%, 100.0%, 60.0%; 82.1%, 66.7%, 62.5%, 50.0%, 60.0%and 89.3%, 83.3%, 75.0%, 50.0% respectively, and there was no operation related death, while 3 patients who refused the further treatment died within 2 months. Conclusion All of inserting double J stent, ultrasound guided renal puncture and drainage, percutaneous renal fistula,ureteral fistula, and hemodialysis are effective treatment methods： Inserting double J stent is the choice treatment for the patients with obstructive nephropathy in the course of radio-therapy for cervical cancer owing to the low complication rate, high satisfaction and radiotherapy completion rate.

关 键 词：宫颈肿瘤/放射疗法 输尿管梗阻/预防和控制 

分 类 号：R692[医药卫生—泌尿科学]