Objective:To investigate the clinical safety and effects of oblique supine lithotomy position percutaneous antegrade ureteral flexible/ rigid endoscopy combined with retrograde ureteroscopy in the treatment of ureteral stent implantation failure ureteral obstruction caused by malignant tumors.Methods:A retrospective study was conducted to collect and analyze the data of 25 patients with ureteral obstruction caused by malignant tumors treated in our hospital from October 2016 to January 2019. All these patients failed of double J stent placement under conventional retrograde cystoscopy or ureteroscopy. Under the oblique supine lithotomy position, a double J tube was placed by percutaneous renal channel antegrade ureteral flexible/ rigid endoscopy combined with ureteroscopy.Results:Double J tubes were successfully placed in 24 cases (30 sides of ureter, 93.7% success rate), except for 1 case failed due to complete occlusions of the bilateral ureteral lumen by tumor invasion. The average operation time was (57.4 ±22.4) minutes and the average hospital stay was (5.5±1.9) days. There was no severe renal hemorrhage and no ureteral perforation and avulsion during the operation. The nephrostomy tube was removed 6- 14 days after the operation. Hydronephrosis was significantly relieved during the 12 months follow-up.Conclusions:Oblique supine lithotomy position percutaneous antegrade ureteral flexible / rigid endoscopy combined with retrograde ureteroscopy for the treatment of ureteral stent implantation failure ureteral obstruction caused by malignant tumors is safe and effective, and worthy of clinical promotion.

恶性肿瘤引起的输尿管梗阻(malignant ureteral obstruction,MUO)通常由盆腔恶性肿瘤局部侵犯或压迫输尿管导致,大多数病例来自妇科、消化道及腹膜后肿瘤,且肿瘤的放化疗导致输尿管周围纤维化会加重梗阻的程度,此类患者如不进行治疗,将很快出现上尿路功能损害,甚至器官功能衰竭.上尿路减压和维持输尿管通畅为首选的治疗方案,治疗的目标是解除输尿管梗阻,避免泌尿系统的并发症,为患者提供继续治疗原发肿瘤的机会.随着技术进步及新材料的开发,各种输尿管支架包括聚合物输尿管支架、金属输尿管支架被应用于临床治疗MUO,为泌尿外科医师提供了更多的选择,同时有助于提高患者生活质量.

目的 探讨保留肾单位手术(NSS)治疗T1b期肾细胞癌(RCC)的临床疗效及术后肾功能变化情况.方法 回顾性分析我院2016年6月至2018年6月行NSS的40例T1b期RCC患者临床资料,并与同期行NSS的52例T1a期RCC患者的临床资料进行比较.进一步分析T1b期RCC患者行NSS术后肾小球滤过率(GFR)变化情况,根据热缺血时间(WIT)将T1b期RCC患者分为短时组(WIT≤25 min)和长时组(WIT＞25 min),比较两组肾功能变化情况.结果 T1b组肿瘤最大径、R.E.N.A.L.评分、手术时间、WIT均高于T1a组,有统计学差异(P＜0.05).两组术中出血量、术后住院时间、输血率、术后并发症、术后6个月总GFR、阳性切缘均无显著差异(P＞0.05).两组患者在随访期间均未发现复发及远处转移.T1b期RCC患者患侧肾脏术后6个月GFR与术前相比明显降低,差异有统计学意义(P＜0.001).T1b期RCC长时组患者患肾术后GFR下降程度明显高于短时组(P＜0.05).结论 NSS治疗T1b期RCC是一种安全有效的治疗方式,手术风险、并发症、术后总GFR及短期肿瘤学预后与T1a期RCC相似,术中应尽量控制WIT在25 min以内.

目的:探索索拉非尼在治疗转移性肾细胞癌(mRCC)患者中的不良反应与疗效之间的关系.方法:回顾性研究西京医院接受索拉非尼治疗的mRCC患者63例,利用卡方检验分析肿瘤控制率与不良反应的发生频率和严重程度的相关性,利用Kaplan-Meier方法分析16种不良反应,筛选出与患者PFS,OS相关的不良反应,将P<0.05变量纳入多变量Cox比例风险回归模型进行进一步的多因素分析,确定独立预后因素.结果:63例接受索拉非尼治疗的患者中,完全缓解2例(3.2％),部分缓解16例(25.4％),疾病稳定37例(58.7％),疾病进展8例(12.7％).中位PFS为12.0个月,中位OS为24.0个月.卡方检验结果示肿瘤控制率与不良反应的发生频率和严重程度相关(均P<0.05).多变量分析显示,更好的PFS的独立预后因素包括腹泻(OR 0.255,95％CI 0.130～0.500,P=0.000)和皮疹(OR 0.235,95％CI 0.114～0.482,P=0.000).OS的独立预后因素包括腹泻(OR 0.454,95％CI 0.246～0.839,P=0.012),皮疹(OR 0.405,95％CI 0.211～0.776,P=0.006)和高血压(OR 0.373,95％CI 0.177～0.784,P=0.009).结论:索拉非尼治疗mRCC患者的疗效与不良反应的发生频率和严重程度呈正相关.皮疹和腹泻是影响PFS的独立保护因素,皮疹,腹泻和高血压是影响OS的独立保护因素.这一结论仍需大量前瞻性研究证实.

肾细胞癌(RCC)是肾脏最常见的恶性疾病,靶向治疗已广泛用于转移性肾细胞癌(mRCC)的治疗中,根据作用机制主要将其分为抗VEGF/VEGFR药物和mTOR抑制剂.索拉非尼能够抑制VEGF受体和PDGF-β受体,是mRCC的一线治疗用药.但仍有在手足综合征、高血压、腹泻等多种不良反应,对患者生活质量造成严重影响,严重亦可危及生命.本文对索拉非尼治疗肾细胞癌的不良反应及处置方面做一综述.