两种术式在缓解恶性输尿管梗阻疗效中的对比研究

Efficacy of two operation methods in relieving malignant ureteral obstruction：a comparative analysis

摘要:

目的 探讨恶性输尿管梗阻（malignant ureteral obstruction，MUO）现有的临床治疗方案和经验，讨论恶性输尿管梗阻时使用经皮肾脏穿刺引流（percutaneous nephrostomy，PN）或输尿管支架置入术（ureteral stenting，US）的临床适用范围，明确2种术式在缓解恶性输尿管梗阻时肾功能损伤的有效性。方法 回顾性纳入重庆医科大学附属第一医院泌尿外科2021年1月至2023年5月诊断为恶性输尿管梗阻的患者，严格筛选纳入及排除标准后共有76例患者入组并随机分为PN组（n=22）与US组（n=54），对患者基本特征及围术期、术后半年随访数据进行病例对照研究以反映肾功能在2组中的差异，采用SPSS 21.0版本对数据进行处理分析。结果 2组患者在性别（P=0.017）、手术侧肾积水程度（P=0.000）的比较，差异有统计学意义。2组患者术前3 d比较尿素氮（P=0.002）、血肌酐（P=0.003），术后1 d尿素氮（P=0.017）、血肌酐（P=0.005），差异有统计学意义。术后3 d与术后6个月2组患者在肾功能比较中差异均无统计学意义。结论 恶性输尿管梗阻以宫颈癌多发，其次为位膀胱癌、结直肠癌等。US可选择梗阻或积水较轻、慢性输尿管梗阻、肾功能损伤较轻的患者，可作为缓解输尿管梗阻的首选治疗方案。PN临床常对中至重度肾积水、肾功能损伤较重或者急性肾功能不全的恶性输尿管梗阻患者进行治疗，可作为US失败的替代方案。

Abstract:

Objective To summarize the current clinical treatment regimens and experience for malignant ureteral obstruction（MUO），to clarify the clinical application scope of percutaneous nephrostomy（PN） and ureteral stenting（US） in managing MUO，and to investigate the efficacy of these two operation methods in relieving renal impairment due to MUO.Methods A retrospective analysis was performed for 76 patients who were diagnosed with MUO in Department of Urology，The First Affiliated Hospital of Chongqing Medical University，from January 2021 to May 2023 and were screened according to strict inclusion and exclusion criteria，and then they were randomly divided into PN group with 22 patients and US group with 54 patients. The two groups were compared in terms of baseline characteristics，perioperative data，and half-year follow-up data，and SPSS 21.0 was used for data analysis.Results There were significant differences between the two groups in sex（P=0.017），degree of hydronephrosis at the operated side（P=0.000），urea nitrogen（P=0.002） and serum creatinine（P=0.003） 3 days before surgery，and urea nitrogen（P=0.017） and blood creatinine（P=0.005） 1 day after surgery. There was no significant difference in renal function between the two groups at 3 days and 6 months after surgery.Conclusion MUO is often observed in cervical cancer，followed by bladder cancer and colorectal cancer. US is suitable for patients with obstruction or mild hydronephrosis，chronic ureteral obstruction，and mild renal impairment，and it can be considered the preferred choice for relieving ureteral obstruction. PN is typically used for the treatment of patients with moderate to severe hydronephrosis，severe renal impairment，or acute renal insufficiency caused by MUO，and it can be used as an alternative in case of the failure of US.