| Objective:To evaluate the application value of flexible ureteroscopy in the diagnosis and treatment of upper urinary acalculous diseases,improve its clinical diagnosis and treatment level of upper urinary acalculous diseases.Methods:A retrospective analysis of our hospital from October 2012 to October 2016 during the flexible ureteroscopy in the diagnosis and treatment of 73 cases of upper urinary tract calculous disease clinical data,including unexplained upper urinary tract hematuria in 48 cases,using Olympus URF-V flexible ureteroscopy the upper urinary tract,combined with NBI model,the suspicious malignant tumor was examined,if proved to be malignant,the same period or within 2 week total nephroureterectomy;Ureteroscopic with holmium laser ablation was performed on a particular type of renal pelvis tumor which requiring renal perservation,regular follow-up of patients with benign;25 cases of renal cystic disease of patients with flexible ureteroscopy endoscopic holmium laser incision drainage treatment.Results:All 73 patients were operated on.(1)There were 48 cases of hematuria in the upper urinary tract,there were 30 males and 18 females,with age 30-75 years,average age 58 years old,with a mean age of 18 years.The average duration of the disease was from 5 days to 3 years(mean,125 days).All the patients were not in advance of indwelling double J tube,a flexible ureteroscope into the mirror was successful in 45 cases(93.8%),3 cases of failure ureteroscopy indwelling double J tube after 2 weeks of the two stage operation success,bronchoscopy and biopsy results showed: 16 cases of renal pelvis and calices tumor(33.3%),4 cases of ureter the tumor(8.3%),6 cases of ureteral polyps(12.5%),4 cases of blood clots(8.3%),and pelvic hemorrhagic inflammation in 8 cases(16.7%),5 cases of renal papilla calcification(10.4%),2 cases of urinary tuberculosis(4.2%),no obvious abnormality was found in 3 cases(6.3%).Among them,5 patients with renal pelvic tumor underwent holmium laser ablation under flexible ureteroscope.The operation time was 40-65 min,with an average of 39 min,and the average length of stay was 2.4 days.All patients were followed up from 2 to 36 m.No severe complications occurred.(2)Flexible ureteroscopy combined with holmium laser incision and drainage in the treatment of renal cyst in 25 cases were operated successfully,13 cases were male,12 were female,aged 34-74 years old,the average age of 55.9 years,cyst diameter was 51.73 + 4.65 mm,28.47 + 6.45 min operation time,intraoperative and postoperative without serious complications,follow-up of 4 ~ 26 m,no cyst recurrence.Conclusions:(1)The diagnosis value of flexible ureteroscopy for upper urinary tract hematuria is high sensitivity and reliability,and can be used as a routine method for the diagnosis of gross hematuria.(2)Flexible ureteroscopy combined with NBI can significantly improve the detection rate of upper urinary tract tumors,combined holmium laser can be used to treat superficial renal pelvis,upper ureter tumors and solitary renal and renal tumors with smaller size,narrower base or pedicle,increase the possibility of conservative treatment of special cases,which is worthy of clinical application and promotion.(3)Holmium laser incision and drainage under flexible ureteroscope for the treatment of renal cyst is safe,effective and repeatable. |
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