软性输尿管镜术在诊断单侧上尿路来源血尿中的作用(附52例报告)

Diagnosis of unilateral hematuria with retrograde flexible ureteroscopic surgery:a report of 52 cases

目的探讨软性输尿管镜术在诊断单侧上尿路来源肉眼血尿病因中的价值.方法回顾分析我院2 0 1 2 年3 月至2 0 1 5 年7 月间5 2 例行软性输尿管镜检术诊断的上尿路来源血尿患者的资料及最终诊断结果.结果5 2 例患者全部完成软性输尿管镜检术.其中3 7 例输尿管全程镜检在半硬输尿管镜下完成,另1 5 例半硬输尿管镜至髂血管平面受阻改用软性输尿管镜观察输尿管至肾盂输尿管交界处.5 2 例中,肾集合系统软性输尿管镜检1 3 例（2 5 . 0 % ） 发现新生物,活检诊断为尿路上皮癌;此1 3 例中男8 例、女5 例,平均年龄6 1 岁（ 5 .8 3 岁） 肿瘤位于左侧7 例、右侧6 例;肾盂4 例、上盏4 例、下盏2 例、中盏及下盏均侵犯3 例;且织活检分级为高级别7 例、低级别6例. 微小静脉破裂1 8 例（3 4 .6 % ） ,血管瘤样病变9 例（1 7 .3 % ） ,静脉曲张出血1 例（1 . 9 % ） , 1 1 例未发现任何病变（2 1 .2 % ） . 上尿路尿路上皮癌患者中1 1 例行肾盂癌根治性切除术,2 例孤立肾患者行软性输尿管镜下肿瘤钬激光融蚀术.非肿瘤病变患者中,9 例血管瘤出血患者行选择性肾动脉栓塞术.所有患者治疗后血尿均消失.1 3 例上尿路尿路上皮癌患者术后病理检查均为浸润性尿路上皮细胞癌（高级别1 0 例,低级别3 例） . 平均随访1 2 个月未见肿瘤复发.结论软性输尿管镜术对于上尿路来源血尿的病因诊断及治疗的选择具有指导意义,应作为此类患者诊断的首选及必要方案.

Objective To analyze the safety and efficacy of retrograde intra-renal surgery using flexible ureteroscopy to diagnose unilateral hematuria. Methods Retrospective analysis of 52 cases of upper urinary tract hematuria in our hospital from March 2012 to July 2015,and analyzed the final diagnosis results. Results All the 52 cases underwent diagnostic flexible ureteroscopy.Among them,37 cases were completed by semi-rigid ureteroscopy,tract in 15 cases,the other 15 cases were obstructed to the iliac vessels,and the flexible ureteroscopy was used to inspect the junction of the renal pelvis and ureter.Endoscopic findings included 13(25.0%)upper urinary neoplasm which was biopsied and confirmed with histology.In these 13 cases,there were male 8cases,5cases of female,mean age was 61years(45to 83 years old);tumors were located in the left side in the 7cases and the right side in 6cases;location in renal pelvis,upper calyx,lower calyx and calyx and lower calyx invasion in 4,4,2and 3cases respectively;and tissue biopsy grading for 7cases of high level and low level in 6cases.The 52 cases included 18(34.6%)venule rupture,9(17.3%)hemangioma,1(1.9%)varix,and 11(21.2%)no lesions.Among the carcinoma cases,11 cases of upper urinary tract epithelial carcinoma underwent radical resection of renal pelvic carcinoma,2cases of solitary kidney were treated with holmium laser ablation of tumor by flexible ureteroscopy.In the cases with benign lesion,9cases were treated with selective renal artery embolism.The symptoms of hematuria disappeared in all cases after treatment.No record of recurrent gross hematuria during the follow-up was reported.The pathology results of all 13 cases with tumor were urothelial carcinomas(10cases of high grade,3cases of low grade). Conclusions Digital flexible ureteroscopy shows great accuracy in diagnosis of pyelocalyceal urothelial carcinomas and other benign lesions with gross hematuria.It is valuable for decision making and should be listed as first-line choice for these kinds of disease.