末端可弯硬性输尿管肾镜检查术在单侧上尿路来源血尿诊断中的临床价值

Clinical value of tip-flexible ureteroscopy in diagnosis of unilateral upper urinary tract hematuria

目的探讨末端可弯硬性输尿管肾镜检查术在单侧上尿路来源血尿诊断中的临床价值。方法回顾性分析2017年1月至2020年6月徐州医科大学附属淮安医院泌尿外科收治的58例使用末端可弯硬性输尿管肾镜检查的单侧上尿路来源血尿患者的临床病历资料。结果58例患者全部顺利完成检查。其中,有19例(32.8%)发现占位性病变,病理活检为尿路上皮癌,男性12例,女性7例;年龄42~84岁,平均年龄(63.8±7.9)岁;肿瘤位于左侧13例,右侧6例;肿瘤位于输尿管上段5例,肾盂8例,肾盏6例;组织活检病理分级为高级别12例,低级别7例。微小静脉破裂16例(27.6%),血管瘤样病变9例(15.5%),纤维上皮息肉4例(6.9%),静脉曲张出血3例(5.2%),余7例(12.1%)未发现任何病变。确诊的19例尿路上皮癌患者均顺利行腹腔镜下根治性肾输尿管切除术,术前彩色多普勒超声、CT尿路成像(CTU)、尿细胞学及末端可弯硬性输尿管肾镜检查总检出率分别为42.1%、84.2%、31.6%和100.0%,CTU与彩色多普勒超声(χ^(2)=7.24,P<0.05)及尿细胞学(χ^(2)=10.08,P<0.05)比较差异有统计学意义,而与末端可弯硬性输尿管肾镜比较,差异无明显统计学意义(χ^(2)=3.26,P>0.05)。末端可弯硬性输尿管肾镜活检与术后病理总体符合率为84.2%,其中高级别符合率91.7%,低级别符合率71.4%。结论末端可弯硬性输尿管肾镜检查术对于单侧上尿路来源血尿患者的病因诊断及治疗方案的选择具有临床指导意义。

Objective To assess the clinical value of tip-flexible ureteroscopy in the diagnosis of unilateral upper urinary tract hematuria.Methods The clinical data of 58 patients with unilateral upper urinary tract hematuria treated at the Department of Urology of Huai'an Hospital Affiliated to Xuzhou Medical University from January 2017 to June 2020 were retrospectively analyzed.Results All the 58 patients completed the examination successfully.Among them,19(32.8%)patients were found to have neoplasms,including 12 males and 7 females.Pathological biopsy showed urothelial carcinoma.Their age ranged from 42 to 84 years old,with an average age of(63.8±7.9)years old.The tumor was located on the left side in 13 cases and on the right side in 6 cases;the tumor was located on the upper ureter in 5 cases,renal pelvis in 8 cases,and calyces in 6 cases;the pathological grade of tissue biopsy was high grade in 12 cases and low grade in 7 cases.16(27.6%)patients had microvascular rupture,9(15.5%)had angiomatous lesions,4(6.9%)had fibroepithelial polyps,3(5.2%)had variceal bleeding,and the remaining 7(12.1%)had no lesions.The total detection rates of lesions by color Doppler ultrasound,CT urography(CTU),urine cytology,and tip-flexible ureteroscopy were 42.1%,84.2%,31.6%,and 100.0%,respectively;there was a significant difference between CTU and color Doppler ultrasound(χ^(2)=7.24,P<0.05)and urine cytology(χ^(2)=10.08,P<0.05),but there was no significant difference between CTU and tip-flexible ureteroscopy(χ^(2)=3.26,P>0.05).The overall coincidence rate of tip-flexible ureteroscopy biopsy and postoperative pathology was 84.2%(91.7%for high grade and 71.4%for low grade).Conclusion Tipflexible ureteroscopy has clinical significance for the etiological diagnosis and treatment of unilateral upper urinary tract hematuria.