输尿管软镜术在上尿路非结石性疾病的应用（附73例报告）

发布时间：2018-03-25 16:00

本文选题：上尿路血尿　切入点：肾盂旁囊肿　出处：《郑州大学》2017年硕士论文

【摘要】：目的:探讨输尿管软镜术在诊断及治疗上尿路非结石性疾病中的应用价值,提高其在上尿路非结石性疾病中的临床诊断和治疗水平。资料与方法:回顾性分析2012年10月至2016年10月期间我院采用输尿管软镜术诊断及治疗的73例上尿路非结石性疾病的临床资料,其中(1)48例上尿路不明原因来源血尿患者采用Olympus URF-V输尿管软镜检查整个上尿路,结合NBI模式对可疑恶性肿瘤进行病检,若证实为恶性,同期或2周内行肾、输尿管全切术;对要求保肾治疗的特殊类型的肾盂肿瘤患者行输尿管软镜下钬激光融蚀治疗,良性患者定期随访;(2)25例肾囊性疾病患者采用输尿管软镜下钬激光内切开引流术治疗。结果:全部73例患者均完成手术。(1)输尿管软镜诊疗上尿路不明原因来源血尿患者48例,其中男30例,女18例,年龄30-75岁,平均年龄58岁;肉眼血尿患者病程5天到3年,平均125天。所有患者术前均未提前留置双J管,输尿管软镜一次进镜成功45例(93.8%),3例进镜失败者留置双J管2周后二期手术成功,镜检及活检结果示:肾盂及肾盏肿瘤16例(33.3%),输尿管肿瘤4例(8.3%),输尿管息肉6例(12.5%),血凝块4例(8.3%),另有肾特发性出血8例(16.7%),肾乳头钙化灶5例(10.4%),泌尿系结核2例(4.2%),未发现明显异常3例(6.3%)。其中5例肾盂肿瘤患者行输尿管软镜下钬激光融蚀治疗,手术时间40-65min,平均39min,平均住院时间2.4天,术后随访2~36m,无严重并发症发生。(2)输尿管软镜下钬激光内切开引流治疗肾囊性疾病25例,均手术成功,其中男13例,女12例,年龄在34-74岁,平均年龄55.9岁,囊肿直径大小51.73±4.65mm,手术时间28.47±6.45min,术中术后无严重并发症发生,随访4~26m,无囊肿复发。结论:(1)输尿管软镜术对上尿路来源血尿的诊断敏感性高,可靠性强,可作为诊断不明原因上尿路肉眼血尿的常规检查方法。(2)电子输尿管软镜联合NBI技术可显著提高上尿路肿瘤的检出率,联合钬激光可用于治疗体积较小、基底窄或带蒂的浅表性肾盂、上段输尿管肿瘤以及孤立肾肾肿瘤,增加特殊病例保守治疗的可能性,值得临床应用及推广。(3)输尿管软镜下钬激光内切开引流治疗内生性肾盂旁囊肿具有安全、有效,复发率低、可重复操作等优势。
[Abstract]:Objective: to evaluate the value of soft ureteroscopy in the diagnosis and treatment of upper urinary tract non-calculous diseases. To improve the clinical diagnosis and treatment of upper urinary tract non-calculous diseases. Data and methods: retrospective analysis of 73 cases of upper urinary tract non-nodulation diagnosed and treated by soft ureteroscopy from October 2012 to October 2016 in our hospital. Clinical data of lithologic diseases, In 48 patients with hematuria of unknown origin of upper urinary tract, the whole upper urinary tract was examined by Olympus URF-V ureteroscopy. The suspected malignant tumor was examined with NBI model. If it was proved malignant, total nephrectomy or ureterectomy was performed at the same time or within 2 weeks. Patients with special types of renal pelvis tumors requiring renal preservation were treated with holmium laser ablation under soft ureteroscope. 25 patients with renal cysts were followed up regularly by holmium: YAG laser incision and drainage under soft ureteroscope. Results: all 73 cases were treated with ureteral soft endoscopy. 48 patients with hematuria of unknown origin of ureteral tract were treated with soft ureteroscopy. There were 30 males and 18 females, aged 30-75 years, with an average age of 58 years. The course of the disease was from 5 days to 3 years, with an average of 125 days. The second stage operation was successful in 45 cases of soft ureteroscopy after 2 weeks of double J tube indwelling in 3 cases of failure of ureteroscopy and 93. 8 cases of failure. The results of microscopic examination and biopsy showed that 16 cases of renal pelvis and calyceal tumors, 4 cases of ureteral tumors, 4 cases of ureteral tumors, 6 cases of ureteral polyps, 12.5 cases of ureteral polyps, 4 cases of hemagglutination, 8 cases of renal idiopathic hemorrhage, 5 cases of renal papillary calcification, 2 cases of urinary tuberculosis, and 2 cases of urinary tuberculosis. Three cases were found to be obviously abnormal. Among them, 5 cases of renal pelvis tumor were treated with holmium laser ablation under soft ureteroscope. The operative time was 40 to 65 minutes (mean 39 minutes, average hospital stay was 2.4 days). The postoperative follow-up was 236m. There were no serious complications. There were 25 cases of renal cystic disease treated by holmium laser internal drainage under soft ureteroscope. All of them were successfully operated on, including 13 males and 12 females, aged from 34 to 74 years. The mean age was 55.9 years, the diameter of cyst was 51.73 卤4.65 mm, the operative time was 28.47 卤6.45 min, and there were no serious complications during and after operation. It can be used as a routine method for the diagnosis of unexplained upper urinary tract hematuria. (2) the detection rate of upper urinary tract tumor can be significantly improved by using electronic ureteroscope combined with NBI. The combination of holmium laser and holmium laser can be used to treat the small size of the tumor. Narrow or pedicled superficial renal pelvis, upper ureteral neoplasms and solitary renal tumors increase the possibility of conservative treatment in special cases. It is worthy of clinical application and extension. 3) the treatment of endopelvic cysts with holmium laser internal incision and drainage under soft ureteroscope is safe, effective, low recurrence rate and repeatable.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699

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