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中華民國泌尿科醫學會雜誌

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篇名 The Current Role of Cutaneous Ureterostomy in Treatment of Pelvic Malignancy
卷期 4:2
並列篇名 輸尿管皮膚造瘻術對骨盆腔癌症治療之角色
作者 周固林文州羅景易張奐光
頁次 1056-1059
關鍵字 urinary diversionureterostomypelvic neoplasmsTSCI
出刊日期 199306

中文摘要

自民國七十四年十二月至民國八十年六月間,馬偕醫院泌尿科共施行181例緩解性尿引流術,其中經皮腎引流術104例(57.5%)雙J形輸尿管導管引流68例(37.6%),而輸尿管皮膚造瘻術只有9例(4.9%)。9例輸尿管皮膚造瘻術中,4例為瘻管形成(包含3例子宮頸癌,1例直腸癌),4例為持續性下泌道出血,另一例為晚期之膀胱癌。此9例手術中,無手術死亡,只1例發生輸尿管壞死及1例發生輸尿管扭曲阻塞,但均能輕易解決。患者之存活期從8天至910天,平均311天,其中5例存活超過六個月。因此,我們認為自經皮腎引流術及雙J形輸尿管導管之應用後,但在某些情況下如晚期之癌症,高危險群患者,無法控制之血尿及瘻管,經皮腎引流術或雙J形導管術失敗者,輸尿管皮膚造瘻術仍不失其應有之治療價值。

英文摘要

From December, 1985 to June, 1991, 181 cases of palliative urinary diversions were performed at Mackay Memorial Hospital. Among these cases, there were 104 (57.5%) percutaneous nephrostomies, 68 (37.6%) double-J ureteral steents, and only 9 cutaneous ureterostomies (4.9%). Cutaneous ureterostomy was performed to correct fistula formation in four cases (three cervical and one rectal cancers), persistent hematuria from lower urinary tract in four cases, and initial treatment for late stage bladder cancer in one. There were no operative mortalities in these nine cases. The two complications – one ureteral necrosis and one obstruction from kinking – were resolved easily. The patients lived for 8 to 910 days, with an average of 311 days. Five of the patients lived for more than six months. With the advent of simpler and safer techniques of percutaneous nephrostomy and double-J ureteral stents, cutaneous ureterostomy is no longer a primary palliative procedure for treatment of pelvic malignancy. However, this procedure is recommended only selectively in high-risk patients with advanced pelvic cancer with life expectancy of more than three months, persistent hematuria or urinary fistula formation, and when double-J insertion or percutaneous nephropstomy fails.