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目的:探讨超声引导下经皮肾穿刺造瘘术(percutaneous nephrostomy,PCN)治疗恶性肿瘤相关性肾积水的方法和并发症。方法:收集2003年6月至2015年12月福建省立医院采用超声引导下PCN治疗恶性肿瘤相关性肾积水患者289例共342侧。97例肾功能不全患者行血液透析治疗4例。穿刺点常规选择后组中盏或下盏,9例侧穿刺前组中盏。采用一步法穿刺置入8F猪尾型造瘘管6例侧,采用Seldinger法置入14F球囊型造瘘管25例侧及开花型肾造瘘管258例311侧。结果:342侧PCN均无大出血及肠道、肝脏、脾脏、胸膜、肺损伤等并发症。2例侧猪尾型造瘘管术后1周内堵塞。7例侧球囊型肾造瘘管头端因置入输尿管上段内而导致引流不畅,3例侧球囊空虚和1例侧重度积水肾萎陷致造瘘管脱出。1例侧开花型肾造瘘管引流失败。8例侧前组中盏穿刺引流成功。81例肾功能不全患者的血清肌酐恢复正常,16例肾功能改善,均无需行后续透析治疗。结论:对恶性肿瘤相关性肾积水采用超声引导下PCN治疗是安全、有效的,经选择的病例穿刺前组盏不会增加并发症。对全身状况较差的患者可选择一步式猪尾型肾造瘘管,对预期寿命较长者或怀疑肾积水合并感染者推荐选择径粗的开花型肾造瘘管。
Objective: To investigate the methods and complications of ultrasound-guided percutaneous nephrostomy (PCN) in the treatment of malignant tumor-associated hydronephrosis. Methods: A total of 289 cases of malignant tumor-associated hydronephrosis were collected from Fujian Provincial Hospital from June 2003 to December 2015 with 342 cases of PCN. Ninety-seven patients with renal insufficiency underwent hemodialysis. Puncture point routine choice in the group after the light or the next light, 9 cases of the side of the former group in the puncture. One-step puncture was used to place 6F pigtails on the 8F pigtails side. Seldinger method was used to implant 25F sides of 14F balloon-type wound fistulas and 258 sides of flowering renal fistulas. Results: There were no major hemorrhage in PCN 342 or complications such as intestinal tract, liver, spleen, pleura and lung injury. 2 cases of pigtail tail fistula occlusion within 1 week after surgery. 7 cases of lateral balloon-type renal fistula head into the upper ureter caused by poor drainage, 3 cases of lateral balloon emptiness and 1 case of hydronephrosis caused by hydrothoracic fistula prolapse. One case of flowering renal fistula drainage failed. 8 cases of anterior group of puncture in the puncture success. 81 cases of renal dysfunction in patients with serum creatinine returned to normal, 16 cases of renal function improved, no follow-up dialysis treatment. CONCLUSIONS: The use of ultrasound-guided PCN for the treatment of malignant tumor-associated hydronephrosis is safe and effective. Complications are not increased in the selected group of cases before puncture. For patients with poor general condition, one-step pigtail nephrostomy may be chosen. For those who have a longer life expectancy or who are suspected to have hydronephrosis, the recommended diameter-flowering nephrostomy tube is recommended.