电子输尿管软镜镜检术在单侧上尿路来源血尿诊断中的价值  

The application of diagnostic digital flexible ureteroscopy in patient with hematuria from unilateral upper urinary tract

作　　者：夏樾[1] 杨嗣星[1] 钱辉军[1] 宋超[1] 廖文彪[1] 陕光[1] Xia Yue;Yang Sixing;Qian Huijun;Song Chao;Liao Wenbiao;Shan Guang(Department of Urology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院泌尿外科,武汉430060

出　　处：《中华泌尿外科杂志》2019年第9期645-649,共5页Chinese Journal of Urology

摘　　要：目的探讨电子输尿管软镜镜检术在单侧上尿路来源血尿诊断中的价值.方法回顾性分析2014年1月至2019年2月武汉大学人民医院140例单侧上尿路来源血尿患者的临床资料.男94例,女46例.中位年龄62.3岁(22 ~ 89岁).因间断性或持续性全程肉眼血尿就诊,其中29例(20.7%)伴有患侧腰腹部疼痛不适症状.中位体质指数24.6 kg/m^2 (22.1~28.2 kg/m^2).泌尿系彩色多普勒超声诊断(包括疑似诊断)上尿路占位性病变47例;CT尿路成像(CTU)诊断(包括疑似诊断)上尿路尿路上皮癌(UTUC) 63例;术前膀胱排出尿细胞学检查阳性17例;膀胱镜检查均排除膀胱、尿道病变,血尿来源于左侧82例(58.6%),右侧58例(41.4%).均全麻下行诊断性电子输尿管软镜镜检术,患者取截石位.术中严格遵循“非接触技术”观念,在观察目标病灶前尽可能避免镜体或导丝所致的输尿管和集合系统黏膜损伤.先以F8/9.8半硬性输尿管镜观察全程输尿管,尽量不使用导丝引导,充分了解输尿管有无病变,如无病变则留置导丝,导丝尖端在肾盂输尿管交界平面以下原位不移动,依据导丝深度放置F12/14输尿管送达鞘(UAS),再置入尖端F9.9的电子输尿管软镜.集合系统镜检顺序为:先肾盂输尿管交界处,然后肾盂、上盏、中盏,最后下盏.术中先镜检整个集合系统后再进行活检.镜检中同时切换窄光谱成像模式提高直视下的视觉效果.镜检过程中采用灌注泵恒压注水,灌注压力≤40 mmHg(1 mmHg=0.133 kPa).所有病例均经UAS取镜检原位冲洗液行尿细胞学检查,可疑病变经工作通道由F3活检钳或套石篮取活检,活检组织送术中冰冻病理检查.良性病变一期治愈定义为肉眼血尿消失,复发定义为肉眼血尿再次出现.恶性病变于根治性肾输尿管切除术(RNU)后即刻单次膀胱腔内灌注吡柔比星或吉西他滨,术后每3个月复查泌尿系彩色多普勒超声和膀胱排出尿细胞学,行膀胱镜活检证�Objective To investigate the value of diagnostic digital flexible ureteroscopy in patient with hematuria from unilateral upper urinary tract. Methods A retrospective analysis was made in consecutive 140 cases, including 94 males and 46 females, who are considered for hematuria from unilateral upper urinary tract in Renmin hospital of Wuhan University from January 2014 to February 2019.Their age ranged from 22 to 89 years, with mean of 62.3 years. The mean BMI was 24.6 kg/m^2(ranging 22.1-28.2 kg/m^2). All patients complained about the continuously or intermittently gross hematuria. 29 cases (20.7%) complained about the flank pain, as well. All cases were examined by urinary sonography, CTU and voided urine cytology preoperatively. Occupying lesion was found in 47 case by sonography including suspected diagnosis. Upper tract urothelial carcinoma(UTUC) was diagnosed in 63 cases by CTU including suspected diagnosis.Voided cytology was positive in 17 cases. Concomitant bladder or urethral lesions were excluded by cystoscopy. Hematuria was confirmed from left side in 82 cases(58.6%) and from right side in 58 cases(41.4%). Diagnostic digital flexible ureteroscopy were performed under general anethesia strictly according to 'No touch technique’. Biopsy for suspicious lesions as well as selective in situ cytology were acquired during ureteroscopy. Results All patients accepted the examination successfully. The duration of follow-up ranged from 3 to 37 months, with mean of 13 month. Benign lesions were found in 71 cases(50.7%) while malignant lesions were identified in 69 cases(49.3%). Benign lesions included 39(54.9%)minute venous rupture, 12 (16.9%)hemangioma, 3 (4.2%)varix and 11 (15.5%)no obvious lesion. The overall success rate of ureteroscopic treatment was 66(93.0%) whereas recurrence rate after treatment was 8(11.3%). Malignant lesions including 67(97.1%) cases with UTUC and 2 cases with squamous carcinoma. The radical nephroureterectomy(RNU)and bladder sleeve resection was performed in all cases. To 67 cases wi

关 键 词：输尿管镜检查 软性输尿管镜 血尿 上尿路 上尿路尿路上皮癌 激光消融术 

分 类 号：R699[医药卫生—泌尿科学]