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目的探讨肾盂膀胱皮下输尿管旁路术治疗晚期肿瘤患者单侧或双侧输尿管梗阻的手术体会及远期效果。方法回顾性分析15例晚期肿瘤(结肠癌、直肠癌术后6例,宫颈癌、卵巢癌9例)患者行17例次肾盂膀胱皮下输尿管旁路术的手术资料及随访情况。结果 15例患者中,2例为双侧输尿管梗阻,行17例次手术,手术均成功,无严重手术并发症。单侧手术时间为(35±12)min。血肌酐由术前的(264±117)μmol/L降低为术后的(113±26)μmol/L(P<0.05);术前生活质量评分(4.2±1.6)分,术后为(7.2±2.4)分(P<0.05)。术后肾盂内感染致梗阻1例;2例患者术后8个月时因梗阻更换导管。结论晚期肿瘤患者转移性病变压迫输尿管引起肾积水,行肾盂膀胱皮下输尿管旁路术创伤小,可有效缓解肾积水、保护肾功能,改善生活质量。
Objective To investigate the surgical experience and long-term efficacy of renal pelvis and bladder subcutaneous ureteral bypass in the treatment of unilateral or bilateral ureteral obstruction in advanced cancer patients. Methods A retrospective analysis of 15 cases of advanced cancer (colon cancer, 6 cases of postoperative rectal cancer, cervical cancer, 9 cases of ovarian cancer) underwent 17 cases of subcutaneous renal pelvis and bladder transurethral bypass surgery data and follow-up. Results Of the 15 patients, 2 were bilateral ureteral obstruction, and 17 had secondary surgery. All the procedures were successful without serious complications. Unilateral surgery time was (35 ± 12) min. Preoperative serum creatinine decreased from (264 ± 117) μmol / L to (113 ± 26) μmol / L postoperatively (P <0.05); preoperative quality of life (4.2 ± 1.6) ± 2.4) points (P <0.05). Postoperative pelvic infection caused obstruction in 1 case; 2 patients due to obstruction at 8 months after catheter replacement. Conclusions The metastatic disease in patients with advanced cancer can cause hydronephrosis due to oppression of ureter, and the traumatic renal pelvic and bladder subcutaneous ureteral bypass is small, which can effectively relieve hydronephrosis, protect renal function and improve quality of life.