国产组合式输尿管纤维软镜在诊治上尿路疾病中的临床应用(附185例报告)

Clinical application of Chinese-made modular flexible ureteroscope in the treatment of upper urinary tract diseases:a report of 185 cases

目的：探讨国产组合式输尿管纤维软镜用于诊治上尿路疾病的有效性和安全性。方法：回顾性分析2013年4月~2015年6月使用国产组合式输尿管纤维软镜完成的185例上尿路疾病手术的临床资料。其中上尿路结石171例,血尿待查9例,肾内占位性病变2例,多囊肾2例,肾盂旁囊肿1例;上尿路结石中最大直径0.8~4.5cm,平均1.83cm。手术方法先以输尿管硬镜行输尿管镜检,然后置入国产组合式输尿管纤维软镜,行软镜下镜检术或碎石术,如行多囊肾或肾盂旁囊肿手术,则采用软镜下钬激光囊肿内切开术。结果：185例病例中有178例行一期输尿管软镜手术,其中包括输尿管软镜钬激光碎石术165例、输尿管软镜镜检术10例和输尿管软镜下囊肿内切开术3例。该组病例无输尿管穿孔撕脱、大出血、脓毒血症等严重并发症发生。随访3个月见输尿管结石清除率为96.3%,肾脏多发性和下盏结石的清除率80.4%,肾盂和肾脏上、中盏结石清除率为93%;多囊肾和肾盂旁囊肿病例未见内切开的囊肿复发。结论：我们认为应用国产组合式输尿管纤维软镜能有效、安全地处理大部分上尿路疾病,是对现有国内进口软镜产品的补充,值得临床使用和推广。

Objective.. To explore the efficacy and safety of use of domestically produced modular flexible uret- eroscope in the treatment of upper urinary tract diseases. Method.. Clinical data of 185 patients with upper urinary tract diseases who were surgically treated with domestically produced modular flexible ureteroscopy were retrospectively analyzed. There were 171 cases of upper urinary tract calculi, 9 cases of hematuresis, 2 cases of space- occupying lesions of the kidney, 2 cases of polycystic kidney and 1 case of parapelvic cyst. The largest diameter of urinary tract calculi ranged from 0.8 to 4.5 cm, with an average of 1.83 cm. The operation began with ureterosco- py with a rigid ureteroscope and then the flexible ureteroscope was introduced for ureteroscopy or lasertripsy. In the cases of polycystic kidney or parapelvic cyst, cyst incision was performed with holmium laser under the flexible ureteroscope. Result： Flexible ureteroscopies, including flexible ureteroscopic lithotripsy with holmium laser （n =165）, flexible ureteroscopic examination （ n = 10） and flexible ureteroscopic incision for cystic diseases （ n = 3）, were successfully performed in 178 out of 185 cases. No severe complications such as ureteral avulsion and perforation, massive haemorrhage or septicopyemia occurred. Three-month follow-up showed that the stone-free rate was 96.3% in patients with ureteral calculi and 80.4% in those with multiple kidney stones and lower calyx calculi and 930//00 in those with renal pelvis calculi, or upper and middle calyceal calculi. Cyst reoccurrence in cases of polycystic kidney and parapelvic cyst was not found. Conclusion： Use of the domestically produced modular flexible ureteroscope is effective and safe for the treatment of the majority of upper urinary diseases. This type of flexible ureteroscope can serve as an alternative to imported flexible ureteroscope in China and is worthy of generalization in clinical practice.