癌症患者輸尿管梗阻及複雜型輸尿管雙 J 支架置換的關聯性和盛行率：一項單中心、二十年回顧性研究

陳立峰、陳汶吉

中國醫藥大學附設醫院 泌尿部

The Prevalence and Association of Complicated Ureteral Double-J Stent Exchange in Patients with Malignant Ureteral Obstruction: A Single-Center, 20 Years Retrospective Study

Lek-Hong Tan, MD, MPH, Wen-Chi Chen, MD, PhD

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Purpose:  Regular replacement of ureteral double J stents (DJs) is the most frequent way to deal with malignant ureteral obstruction because it is less invasive and has a lower risk of bleeding than other methods. However, the occurrence of DJs complications often leads to frequent stent exchange. This study aims to investigate the prevalence and the association of complicated DJs exchange in cancer patients who need to maintain patency of ureter.

Materials and Methods:  Data of patients with DJs replacement between 2000 and 2020 from the medical records of China Medical University hospital were included. Complicated DJs exchange was defined as replacing DJs more than two times within six months. The primary outcomes were the prevalence rates and the association (odds ratio [OR]) of complicated DJs exchange in patients with cervical cancer, ureter cancer, colorectal cancer, and renal pelvis cancer.

Results:  Based on quantitative analysis of the data of 4781 patients, the prevalence of complicated DJs exchange in cervical cancer, ureter cancer, colorectal cancer, and renal pelvis cancer were 63.9% (95% confidence interval [CI] 56.1%-71.0%), 27.0% [95% CI 20.1%-33.9%], 27.0% [95% CI 22.7%-32.1%], and 9.4% [95% CI 6.5%-13.4%], respectively. The overall presence of cancer was significantly associated with complicated DJs exchange, with OR 3.7 [95% CI 3.1-4.5, p<0.0001]. Presence of cervical cancer, ureter cancer, colorectal cancer, or renal pelvis cancer was significantly associated with complicated DJs exchange, with OR 26.6 [95% CI 18.5-38.2, p<0.0001], OR 5.7 [95% CI 3.9-8.0, p<0.0001], OR 5.6 [95% CI 4.2-7.4, p<0.0001], and 1.6 [95% CI 1.0-2.4, p<0.05], respectively.

Conclusions:  We found significant associations between cancer and complicated DJs exchange, long-term DJs exchange in such patients may cause a high rate of complications and impair the quality of life. Lastly, this study shows that the prevalence of complicated DJs exchange in cervical cancer is the highest compared with other cancer. Therefore, searching alternative methods to maintain the patency of the collecting system should be considered in these patients.