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目的探讨经皮下肾膀胱分流术治疗盆腹腔晚期肿瘤引起的输尿管梗阻的临床价值。方法 2009年12月~2012年5月,15例晚期腹腔盆腔肿瘤致输尿管中下段梗阻患者,双侧1例,左侧8例,右侧6例,经输尿管镜置入双J管失败。超声检查显示患侧肾盂积水宽度3.3~8.9 cm,(4.2±2.6)cm。磁共振水成像显示患侧输尿管完全梗阻。使用美国巴德公司肾膀胱分流套件,行经皮下肾膀胱分流术15例(16侧)。术后复查超声、KUB平片、血肌酐及患侧肾小球滤过率。结果手术均成功,术后1周复查超声,患侧肾积水宽度1.7~4.6 cm,(2.6±1.8)cm(与术前相比,t=5.356,P=0.025)。血肌酐由(256±46)μmol/L下降至(124±23)μmol/L(t=12.351,P=0.006)。患侧肾小球滤过率由(25.4±4.8)ml/min上升至(45.6±5.3)ml/min(t=3.784,P=0.016)。结论经皮下肾膀胱分流术简单易行,创伤小,能改善因输尿管梗阻而受损的肾功能,提高生活质量。
Objective To investigate the clinical value of transcutaneous subcutaneous nephroureterectomy in the treatment of ureteral obstruction caused by advanced pelvic and abdominal tumors. Methods From December 2009 to May 2012, 15 patients with late-stage pelvic peritoneal ureteral obstruction caused by mid-lower ureter obstruction, 1 patient on both sides, 8 patients on the left and 6 patients on the right. Ureteroscopic double-J tube failed. Ultrasonography showed ipsilateral hydronephrosis width 3.3 ~ 8.9 cm, (4.2 ± 2.6) cm. Magnetic resonance water imaging showed complete ileal ureteral obstruction. Fifteen patients (16 sides) underwent subcutaneous renal bladder shunting using the American Barr Company Kidney Bladder Shunt Kit. Postoperative ultrasound, KUB plain film, serum creatinine and ipsilateral glomerular filtration rate. Results The operation was successful. Ultrasound was performed one week after operation. The width of hydronephrosis was 1.7-4.6 cm (2.6 ± 1.8) cm (t = 5.356, P = 0.025). Serum creatinine decreased from (256 ± 46) μmol / L to (124 ± 23) μmol / L (t = 12.351, P = 0.006). The ipsilateral glomerular filtration rate increased from (25.4 ± 4.8) ml / min to (45.6 ± 5.3) ml / min (t = 3.784, P = 0.016). Conclusion Transcutaneous subcutaneous renal shunt is simple, less traumatic, can improve renal function damaged by ureteral obstruction and improve quality of life.