臨牀透析 Vol.21 No.4(6-2)


特集名 末期腎不全患者の悪性腫瘍
題名 悪性腫瘍合併症としての腎不全 (2) 尿路閉塞
発刊年月 2005年 04月
著者 橋本 恭伸 東京女子医科大学泌尿器科
著者 田邊 一成 東京女子医科大学泌尿器科
著者 東間 紘 東京女子医科大学泌尿器科
【 要旨 】 末期担癌患者では,後腹膜への局所浸潤やリンパ行性転移により腎尿路系の通過障害を引き起こし腎後性腎不全が生じる.片側上部尿路閉塞は問題ないが,両側上部尿路閉塞や下部尿路閉塞はoncogenic emergencyの一つである.また末期担癌患者の長期予後が可能になると,適切な尿路のドレナージを行いQOLを保つことは重要である.上部尿路閉塞では尿管ステント,あるいは腎瘻が選択され,下部尿路閉塞では尿道カテーテル,または膀胱瘻が選択される.
Theme Malignant Tumors in Patients with End-Stage Renal Failures
Title Renal failure as complication of malignant tumor -- urinary tracts obstruction
Author Yasunobu Hashimoto Department of Urology, Tokyo Women's Medical University
Author Kazunari Tanabe Department of Urology, Tokyo Women's Medical University
Author Hiroshi Toma Department of Urology, Tokyo Women's Medical University
[ Summary ] In terminal oncogenic terminal patients, cancer cells obstruct urinary passage and cause post renal failure by invasion of the retroperitoneal space and lymphatic metastasis. Obstruction of one side of the urinary tract is not critical. However, obstruction of both sides of upper urinary tract and the lower tract constitute a major oncogenic emergency. Moreover, when a long remaining life time is possible in terminal oncogenic patients it is important to maintain their quality of life by selecting appropriate methods for drainage of obstructed urine. For obstructions of the upper urinary tract either ureteral stents or percutaneous nephrostomy are selected. For those of the lower urinary tract, either urethral stents were used or percutaneous cystostomies were performed. Doctors who are not urologists and their staffs should know the mechanisms for alleviating urinary obstructions, including proper timing and management of stents, to produce proper catheter drainage.
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