Clinical course in patients with percutaneous nephrostomy for hydronephrosis associated with advanced cancer

Abstract

経皮的腎瘻(PNS)を造設した水腎症合併進行癌症例33例を対象に, 原疾患の種類, PNS造設前のperformance status(PS), PNS造設後の在宅期間, カテーテル交換回数, カテーテルの種類, 合併症について調べた.その結果, 生存期間中央値は3.0ヵ月であった.全症例の69.7%は退院が不可能であった.30例は原疾患により死亡していた.原疾患別の生存期間中央値は上部消化管癌, 大腸癌, 泌尿器科癌, 婦人科癌でそれぞれ1.5, 5.5, 3.0, 3.0ヵ月であった(p=0.0116).18例(54.5%)で腎盂腎炎, カテーテル閉塞, カテーテル抜去などの合併症を経験していた.カテーテルの種類と合併症頻度に関連は見られなかった.以上, PNSは水腎症合併進行癌症例に対し適した尿路変向術であり, 一側の造設により致死的な腎後性腎不全を回避できる.しかし必ずしも患者のQOL改善は期待できず, いかなるカテーテルを用いても合併症のリスクは不可避であると考えられた

We investigated the clinical courses of 33 patients with advanced malignancies who has undergone percutaneous nephrostomy (PNS) to clarify the efficacy and validity of PNS and evaluated the results according to the type of catheter. The pigtail, Malecot and balloon catheters were used. All the catheters were exchanged every 4 weeks, if necessary for larger ones. The site of the primary disease, preoperative performance status, duration of time spent at home after PNS construction, number of times the catheter was changed, type and size of the catheter and complications associated with PNS were compiled. The median overall survival was 3.0 months. Twenty-three patients (69.7%) were never discharged from hospital. Thirty patients died of their primary diseases. The median overall survival of patients with cancers of the upper gastrointestinal system, large bowel, urological organs and gynecologic organs were 1.5, 5.5, 3.0 and 3.0 months, respectively (p=0.0116). Eighteen patients (54.5%) experienced complications such as pyelonephritis, obstruction, dislodgement and so on. PNS is an appropriate urinary diversion for patients with hydronephrosis with advanced cancer and unilateral construction is effective for treating end-stage obstructive renal failure. However, PNS rarely improves the patient's quality of life and the risk of complications is unavoidable regardless of the type of catheter used.