Management of ureteral obstruction in advanced testicular tumor with lymph node metastasis
Management of ureteral obstruction in advanced testicular tumor with lymph node metastasis
复制标题
晚期睾丸肿瘤伴淋巴结转移输尿管梗阻的处理
DOI：
10.1093/jjco/hys094
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发表时间：
2012
期刊：
影响因子：
2.4
通讯作者：
Nishiyama H.
中科院分区：
文献类型：
--
作者：
Ikeda A;Kawai K;Miyazaki J;Nishiyama H.
目的：输尿管梗阻是睾丸肿瘤伴腹膜后淋巴结转移的并发症之一，需要输尿管支架置入术治疗。我们对留置输尿管支架患者输尿管梗阻的临床过程和肾功能的变化进行了阐述。方法回顾性分析我院2002 ~ 2010年收治的56例转移性睾丸肿瘤化疗患者的临床资料。结果56例患者中，12例患者在化疗前需要输尿管支架植入术。精原细胞瘤患者需要输尿管支架植入术的比例明显高于非精原细胞瘤患者（分别为47%和12%，P< 0.05）。除1例患者在化疗期间因癌症死亡外，所有患者均在化疗或腹膜后淋巴结清扫后取出输尿管支架。在腹膜后淋巴结清扫术中，3例患者保留输尿管，1例患者需要部分输尿管切除术，无一例患者行辅助肾切除术。11例患者在中位随访44个月时均未出现局部和远处复发。输尿管支架置入使所有患者化疗前肾小球滤过率估测值均高于60ml /min，化疗后11例患者中有6例肾小球滤过率估测值降至< 60ml /min。结论经化疗或腹膜后淋巴结清扫后，睾丸肿瘤所致的输尿管梗阻得到缓解。输尿管支架置入术对化疗前肾功能的改善是有效的，但化疗中或化疗后肾功能的恶化应特别注意。
ObjectiveUreteral obstruction is one of the complications of testicular tumor with retroperitoneal lymph node metastasis that requires ureteral stenting for management. We elucidated the clinical courses of ureteral obstructions and changes in renal functions in patients with indwelling ureteral stenting.MethodsThe medical records of 56 patients who were treated for metastatic testicular tumors by chemotherapy at a single institute between 2002 and 2010 were retrospectively reviewed.ResultsAmong 56 patients, 12 patients needed ureteral stenting before chemotherapy. The proportion of patients requiring ureteral stenting was significantly higher in seminoma than non-seminoma (47 and 12%, respectively,P< 0.05). The ureteral stent was removed after chemotherapy or retroperitoneal lymph node dissection in all patients, except for one patient who died of cancer during chemotherapy. At retroperitoneal lymph node dissection, ureters were spared in three patients, a partial ureterectomy was needed in one patient, and no case underwent adjunctive nephrectomy. These 11 patients presented no local and distant recurrence at median follow-up of 44 months. Ureteral stenting increased the estimated glomerular filtration rate to more than 60 ml/min before chemotherapy in all patients, but it decreased to <60 ml/min in 6 of 11 patients after chemotherapy.ConclusionsUreteral obstruction due to testicular tumor was relieved after chemotherapy or retroperitoneal lymph node dissection. Ureteral stenting was effective to improve renal function before chemotherapy, although we should pay special attention to deterioration of renal function during or after chemotherapy.