组合式输尿管软镜在上尿路疾病诊治中的应用

Application of modular flexible ureteroscope in diagnosis and treatment of upper urinary tract desease

目的 探讨组合式输尿管软镜在诊断和治疗上尿路疾病中的临床应用价值.方法 组合式输尿管软镜经尿道完成上尿路疾病的诊断和治疗75例,采用输尿管硬镜镜体扩张后留置输尿管扩张鞘,再置入输尿管软镜进一步诊疗,其中应用钬激光及U100激光治疗上尿路结石62例.诊断无痛性肉眼血尿13例.结果 62例上尿路结石患者中,其中59例输尿管软镜下激光顺利将结石击碎,碎石成功率95.16％ （59/62）,术后3～4周后复查KUB或上腹部CT平扫,提示结石清除率为83.8％ （52/62）.13例无痛性血尿患者中,9例术中快速冰冻病理为尿路上皮癌,一期行肾盂癌根治术（肾、输尿管全长切除及膀胱输尿管开口袖套状切除）.术后病理检查均为浸润性尿路上皮细胞癌（高级别8例,低级别1例）,4例未发现肾盂、肾盏实性占位病变.结论 输尿管软镜手术是一种有效、安全、微创的上尿路诊断和治疗方法,特别是组合式输尿管软镜,其对上尿路疾病的微创诊疗将有着更广泛的临床应用价值.

Objectives To discuss the clinic application value of modular flexible ureteroscope in diagnosis and treatment of upper urinary tract desease.Methods Used modular flexible ureteroscope to diagnose and treat 75 patients of upper urinary tract desease.Used ureteroscope lens body to expand the ureter and indwell ureteral expansion sheath,then treated the patients with flexible ureteroscope.There were 62 cases treated with holmium laser and U100 laser.13 cases were painless gross hematuria.Results In 62 patients of upper urinary tract calculus,59 successfully broke stones by the laser of flexible ureteroscope.The success rate was 95.16％ （59/62）.After 3-4 weeks of operation,these patients were reviewed by KUB or CT of midsection.The results revealed the stone clearance rate was 83.8％ （52/62）.In 13 patients of painless gross hematuria,9 cases were diagnosed urothelium carcinoma by frozen section and treated with renal pelvis carcinoma radical operation at first-stage （include kidney,ureter resection and bladder ureter cuff excision）.Pathological examination after operation revealed they were invasive urothelial cell carcinoma （high-grade 8 cases,low-grade 1 case）.4 cases were without space occupying lesion in renal pelvis and calices.Conclusions Flexible ureteroscope,expecially modular flexible ureteroscope is an effective,security and minimally invasive diagnosis and treatment method for upper urinary tract desease.It will have extensive clinic application value in minimally invasive therapy of upper urinary tract desease.