诊断性数字柔性输尿管镜在单侧上尿路血尿中的应用

Q4 Medicine

中华泌尿外科杂志 Pub Date : 2019-09-15 DOI:10.3760/CMA.J.ISSN.1000-6702.2019.09.002

Yue Xia, Sixing Yang, H. Qian, Chao Song, W. Liao

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Occupying lesion was found in 47 case by sonography including suspected diagnosis. Upper tract urothelial carcinoma(UTUC) was diagnosed in 63 cases by CTU including suspected diagnosis.Voided cytology was positive in 17 cases. Concomitant bladder or urethral lesions were excluded by cystoscopy. Hematuria was confirmed from left side in 82 cases(58.6%) and from right side in 58 cases(41.4%). Diagnostic digital flexible ureteroscopy were performed under general anethesia strictly according to 'No touch technique’. Biopsy for suspicious lesions as well as selective in situ cytology were acquired during ureteroscopy. \n \n \nResults \nAll patients accepted the examination successfully. The duration of follow-up ranged from 3 to 37 months, with mean of 13 month. Benign lesions were found in 71 cases(50.7%) while malignant lesions were identified in 69 cases(49.3%). Benign lesions included 39(54.9%)minute venous rupture, 12 (16.9%)hemangioma, 3 (4.2%)varix and 11 (15.5%)no obvious lesion. The overall success rate of ureteroscopic treatment was 66(93.0%) whereas recurrence rate after treatment was 8(11.3%). Malignant lesions including 67(97.1%) cases with UTUC and 2 cases with squamous carcinoma. The radical nephroureterectomy(RNU)and bladder sleeve resection was performed in all cases. To 67 cases with UTUC, the overall identification rate of urinary sonography, CTU, voided urine cytology, selective in situ cytology and diagnostic digital flexible ureteroscopy was 41(61.2%), 61(91.0%), 13(19.4%), 38(56.7%) and 63(94.0%) respectively. Identification rate of selective in situ cytology was superior to voided cytology(P<0.01) while diagnostic digital flexible ureteroscopy was no significant difference compared with CTU. The concordance of pathological grade between biopsy and final resection specimen was 73.1%.The concordance of low grade was 93.3% whereas high grade was 56.8%. Up-grading was found in 16(23.9%) cases while down-grading was found in 2(3.0%) cases. 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引用次数: 0

摘要

目的探讨数字柔性输尿管镜对单侧上尿路血尿的诊断价值。方法对武汉大学人民医院2014年1月至2019年2月收治的140例单侧上尿路血尿患者进行回顾性分析，其中男性94例，女性46例，年龄22-89岁，平均62.3岁。平均BMI为24.6 kg/m2（范围为22.1-28.2 kg/m2）。所有患者均抱怨持续或间歇性肉眼血尿。29例（20.7%）患者同时伴有腰痛。所有病例术前均行尿路超声、CTU及尿液细胞学检查。超声检查发现占位性病变47例，包括可疑诊断。CTU共诊断出63例上尿路上皮癌（UTUC），其中包括可疑诊断。空洞细胞学检查阳性17例。膀胱镜检查排除伴随的膀胱或尿道病变。诊断为左侧血尿82例（58.6%），右侧血尿58例（41.4%）。在输尿管镜检查期间，对可疑病变进行了活检和选择性原位细胞学检查。结果所有患者均顺利接受检查。随访时间3～37个月，平均13个月。良性病变71例（50.7%），恶性病变69例（49.3%），良性病变包括39例（54.9%）微小静脉破裂、12例（16.9%）血管瘤、3例（4.2%）静脉曲张和11例（15.5%）无明显病变。输尿管镜治疗的总成功率为66例（93.0%），而治疗后复发率为8例（11.3%）。恶性病变包括67例（97.1%）UTUC和2例鳞状细胞癌。所有病例均行根治性肾输尿管切除术（RNU）和膀胱袖切除术。在67例UTUC患者中，尿液超声、CTU、尿液细胞学、选择性原位细胞学和诊断性数字柔性输尿管镜的总识别率分别为41（61.2%）、61（91.0%）、13（19.4%）、38（56.7%）和63（94.0%）。选择性原位细胞学检查的鉴别率优于空白细胞学检查（P<0.01），而诊断性数字输尿管软镜检查与CTU相比无显著差异。活检与最终切除标本的病理分级符合率为73.1%。低分级符合率93.3%，高分级符合率56.8%。16例（23.9%）病例分级上调，2例（3.0%）病例分级下调。在随访期间，11例（16.4%）患者确认膀胱内复发。结论诊断性数字柔性输尿管镜不仅可以为单侧上尿路血尿的病因诊断提供定性和定位的证据，还可以为治疗提供策略选择。关键词：输尿管镜；柔性输尿管镜；血尿；上尿路；上尿路上皮癌；激光消融

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The application of diagnostic digital flexible ureteroscopy in patient with hematuria from unilateral upper urinary tract

Objective To investigate the value of diagnostic digital flexible ureteroscopy in patient with hematuria from unilateral upper urinary tract. Methods A retrospective analysis was made in consecutive 140 cases, including 94 males and 46 females, who are considered for hematuria from unilateral upper urinary tract in Renmin hospital of Wuhan University from January 2014 to February 2019.Their age ranged from 22 to 89 years, with mean of 62.3 years. The mean BMI was 24.6 kg/m2(ranging 22.1-28.2 kg/m2). All patients complained about the continuously or intermittently gross hematuria. 29 cases (20.7%) complained about the flank pain, as well. All cases were examined by urinary sonography, CTU and voided urine cytology preoperatively. Occupying lesion was found in 47 case by sonography including suspected diagnosis. Upper tract urothelial carcinoma(UTUC) was diagnosed in 63 cases by CTU including suspected diagnosis.Voided cytology was positive in 17 cases. Concomitant bladder or urethral lesions were excluded by cystoscopy. Hematuria was confirmed from left side in 82 cases(58.6%) and from right side in 58 cases(41.4%). Diagnostic digital flexible ureteroscopy were performed under general anethesia strictly according to 'No touch technique’. Biopsy for suspicious lesions as well as selective in situ cytology were acquired during ureteroscopy. Results All patients accepted the examination successfully. The duration of follow-up ranged from 3 to 37 months, with mean of 13 month. Benign lesions were found in 71 cases(50.7%) while malignant lesions were identified in 69 cases(49.3%). Benign lesions included 39(54.9%)minute venous rupture, 12 (16.9%)hemangioma, 3 (4.2%)varix and 11 (15.5%)no obvious lesion. The overall success rate of ureteroscopic treatment was 66(93.0%) whereas recurrence rate after treatment was 8(11.3%). Malignant lesions including 67(97.1%) cases with UTUC and 2 cases with squamous carcinoma. The radical nephroureterectomy(RNU)and bladder sleeve resection was performed in all cases. To 67 cases with UTUC, the overall identification rate of urinary sonography, CTU, voided urine cytology, selective in situ cytology and diagnostic digital flexible ureteroscopy was 41(61.2%), 61(91.0%), 13(19.4%), 38(56.7%) and 63(94.0%) respectively. Identification rate of selective in situ cytology was superior to voided cytology(P<0.01) while diagnostic digital flexible ureteroscopy was no significant difference compared with CTU. The concordance of pathological grade between biopsy and final resection specimen was 73.1%.The concordance of low grade was 93.3% whereas high grade was 56.8%. Up-grading was found in 16(23.9%) cases while down-grading was found in 2(3.0%) cases. Intravesical recurrence was affirmed in 11(16.4%) cases during follow-up. Conclusions Diagnostic digital flexible ureteroscopy may not only present qualitative as well as localized evidence for etiological diagnosis of hematuria from unilateral upper urinary tract, but also provides strategy choice for treatment. Key words: Ureteroscopy; Flexible ureteroscope; Hematuria; Upper urinary tract; Upper tract urothelial carcinoma; Laser ablation

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来源期刊

中华泌尿外科杂志 Medicine-Nephrology

CiteScore

0.10

自引率

0.00%

发文量

14180

期刊介绍： Chinese Journal of Urology (monthly) was founded in 1980. It is a publicly issued academic journal supervised by the China Association for Science and Technology and sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. This journal mainly reports on the latest scientific research results and clinical diagnosis and treatment experience in the professional field of urology at home and abroad, as well as basic theoretical research results closely related to clinical practice. The journal has columns such as treatises, abstracts of treatises, experimental studies, case reports, experience exchanges, reviews, reviews, lectures, etc. Chinese Journal of Urology has been included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences), CSCD Chinese Science Citation Database Source Journal (including extended version), and also included in American Chemical Abstracts (CA). The journal has been rated as a quality journal by the Association for Science and Technology and as an excellent journal by the Chinese Medical Association.