本文選題：上尿路血尿　切入點(diǎn)：腎盂旁囊腫　出處：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的:探討輸尿管軟鏡術(shù)在診斷及治療上尿路非結(jié)石性疾病中的應(yīng)用價值,提高其在上尿路非結(jié)石性疾病中的臨床診斷和治療水平。資料與方法:回顧性分析2012年10月至2016年10月期間我院采用輸尿管軟鏡術(shù)診斷及治療的73例上尿路非結(jié)石性疾病的臨床資料,其中(1)48例上尿路不明原因來源血尿患者采用Olympus URF-V輸尿管軟鏡檢查整個上尿路,結(jié)合NBI模式對可疑惡性腫瘤進(jìn)行病檢,若證實(shí)為惡性,同期或2周內(nèi)行腎、輸尿管全切術(shù);對要求保腎治療的特殊類型的腎盂腫瘤患者行輸尿管軟鏡下鈥激光融蝕治療,良性患者定期隨訪;(2)25例腎囊性疾病患者采用輸尿管軟鏡下鈥激光內(nèi)切開引流術(shù)治療。結(jié)果:全部73例患者均完成手術(shù)。(1)輸尿管軟鏡診療上尿路不明原因來源血尿患者48例,其中男30例,女18例,年齡30-75歲,平均年齡58歲;肉眼血尿患者病程5天到3年,平均125天。所有患者術(shù)前均未提前留置雙J管,輸尿管軟鏡一次進(jìn)鏡成功45例(93.8%),3例進(jìn)鏡失敗者留置雙J管2周后二期手術(shù)成功,鏡檢及活檢結(jié)果示:腎盂及腎盞腫瘤16例(33.3%),輸尿管腫瘤4例(8.3%),輸尿管息肉6例(12.5%),血凝塊4例(8.3%),另有腎特發(fā)性出血8例(16.7%),腎乳頭鈣化灶5例(10.4%),泌尿系結(jié)核2例(4.2%),未發(fā)現(xiàn)明顯異常3例(6.3%)。其中5例腎盂腫瘤患者行輸尿管軟鏡下鈥激光融蝕治療,手術(shù)時間40-65min,平均39min,平均住院時間2.4天,術(shù)后隨訪2~36m,無嚴(yán)重并發(fā)癥發(fā)生。(2)輸尿管軟鏡下鈥激光內(nèi)切開引流治療腎囊性疾病25例,均手術(shù)成功,其中男13例,女12例,年齡在34-74歲,平均年齡55.9歲,囊腫直徑大小51.73±4.65mm,手術(shù)時間28.47±6.45min,術(shù)中術(shù)后無嚴(yán)重并發(fā)癥發(fā)生,隨訪4~26m,無囊腫復(fù)發(fā)。結(jié)論:(1)輸尿管軟鏡術(shù)對上尿路來源血尿的診斷敏感性高,可靠性強(qiáng),可作為診斷不明原因上尿路肉眼血尿的常規(guī)檢查方法。(2)電子輸尿管軟鏡聯(lián)合NBI技術(shù)可顯著提高上尿路腫瘤的檢出率,聯(lián)合鈥激光可用于治療體積較小、基底窄或帶蒂的淺表性腎盂、上段輸尿管腫瘤以及孤立腎腎腫瘤,增加特殊病例保守治療的可能性,值得臨床應(yīng)用及推廣。(3)輸尿管軟鏡下鈥激光內(nèi)切開引流治療內(nèi)生性腎盂旁囊腫具有安全、有效,復(fù)發(fā)率低、可重復(fù)操作等優(yōu)勢。
[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 鹵4.65 mm, the operative time was 28.47 鹵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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R699

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