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題名 | Gastric Cancer with Obstructive Uropathy:Clinical Experience with 17 Cases=胃癌併發阻塞性泌尿路病變:17例的臨床經驗 |
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作 者 | 廖宗琦; 莊正鏗; 陳仁熙; 張獻崑; | 書刊名 | 長庚醫學 |
卷期 | 20:4 1997.12[民86.12] |
頁次 | 頁286-292 |
分類號 | 415.527 |
關鍵詞 | 輸尿管阻塞; 胃癌; 皮下腎造口管; 輸尿管導流管; Ureteral obstruction; Gastric cancer; Percutaneous nephrostomy; Ureteral stent; |
語文 | 英文(English) |
中文摘要 | 背景:胃癌造成輸尿管阻塞的成因為腫瘤特移至動脈旁淋巴結或骨盆腔區導致。 方法:自民國73年1月至85年12月,林口長庚醫院回顧了17名胃癌併發阻塞性泌尿路病 變的病人。病理組織有12例(70%)為分化不良的腺癌。 結果:輸尿管阻塞的位置有7例在近側,有7例在遠側,及3例為多發位。輸尿管的黏膜層 少受影響。其中有3例,阻塞性泌尿路病變為癌症的最初表徵。每位病人在輸尿管阻塞時腹 膜均有癌細胞轉移。而且大部分病人可檢查出有明顯的動脈旁淋巴或者有骨盆腔轉移。關於 輸尿管阻塞的處理,有8例做了經由皮下腎造口管引流(percutaneous nephrostomy);有 9例從膀胱鏡放置了輸尿管的導流管(ureteral stent),其中8例用的是雙J型導流管 (double-J ureteral stent)。放置雙J型導流管時,有1例無法弄進,有4例在1個月內 發生了導流管塞住。失敗的4例有3例成功的改成經由皮下腎造口管引流。 結論:胃癌併發阻塞性泌尿路病變可發生在輸尿管的任何部位。雙J型箏流管的失敗率高, 如失敗我們應儘快改成經由皮下腎造口管引流。我們也可開始即經由皮下腎造口管引流來維 護腎功能。 |
英文摘要 | Background: Gastric cancer can spread to either the paraaortic area or pelvis causing ureteral obstruction. Method: Between 1984 and 1996, 17 patients with gastric cancer were proven to have obstructive uropathy (OU). Of these, 12 (70%) had poorly differentiated adenocarcinomas. Results: The obstructed levels were at the proximal ureter (7 cases), distal ureter (7 cases), and at multiple sites in the ureter (3 cases). The mucosa of the ureter tended to be spared. In 3 cases, OU was the initial presentation. Peritoneal carcinomatosis was noted in all cases. Most cases demonstrated obvious paraaortic lymph node and/or pelvic metastases. Management of ureteral obstruction included percutaneous nephrostomy (PCN) in 8 cases, and cystoscopic placement of a ureteral stent in 9 cases with double-J stents used in 8. Insertion of the double-J stent failed in I case initially. Four cases using double-J stents resulted in occlusion within I month, of which 3 subsequently were successfully changed to PCN. Conclusion: Gastric cancer with OU can obstruct the ureter at any level. Double-J stents exhibited a high failure rate in these patients necessitating a switch to PCN. We could also choose PCN as the initial procedure to preserve renal function. |
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