输尿管纤维上皮性息肉的腔内治疗

目的 总结输尿管镜下钬激光切除纤维上皮性息肉的经验.方法 输尿管纤维上皮性息肉患者5例,息肉根部位于输尿管上段2例、中段2例、下段1例.息肉长3～16 cm,其中息肉自输尿管口部分脱入膀胱者2例.患侧腰痛者3例、血尿者4例、体检发现肾积水就诊者1例.均行输尿管镜下钬激光息肉切除,其中2例脱入膀胱者先行经尿道部分肿物切除.术后均留置双J管,6～8周拔除.结果 5例手术均顺利完成,术中无并发症.术后病理报告组织中央见血管纤维束,大量纤维组织,散在炎性细胞浸润,表面移行上皮增生,部分黏膜下有移行细胞团,为纤维上皮性息肉.术后平均住院3(2～5)d.5例平均随访24(3～51)个月,均无复发;1例术后3个月发现输尿管狭窄,再次行输尿管镜下钬激光狭窄内切开术治愈.结论 腔内手术是治疗输尿管纤维上皮性息肉的有效方法,具有损伤小、并发症少、恢复快的特点.钬激光可以采用更小121径的输尿管镜以及输尿管软镜,提高了手术成功率.

Endoscopic treatment of ureteral fibroepithlial polyp

Objective To report the experience on the ureteroscopic treatment of ureteral fibro-epithlial polyp by Holmium:YAG laser resection.Methods Of five cases,the polyp was located in the upper 1 third of the ureter in 2 cases,and in middle 1 third or ureter in 2 cases,in lower 1 third of ureter in 1 case.The length of the polyps ranged from 3 to 16 cm.Three patients presented with flank pain,4 with hematuria and 1 with hydronephrosis.Five patients underwent rigid ureteroscopic treat-ment.TUR was performed in the 2 polyp cases with prolapsing from the ureteral orifice.A Holmium:YAG laser was used to resect ureteral polyps.At the end of the procedure,a 7 F double-J ureteral stent was placed and indwelling for 6- 8 weeks.Results All operations were successfully done.The pathologic diagnosis were fibroepithelial polyp.Histologically,the polyps were composed of a central fibrovascular core surrounded by hyperplastic benign urothelium.The stroma of polyp consis-ted of fibrous connective tissue with minimal cellular infiltration,and occasional epithelial cell nests were seen.The average length of hospital stay was 3 d (range 2 to 5).The mean follow-up was 24 months (range 3 to 51),and all patients remained no recurrence.One patient developed a ureteral stricture 3 months after the treatment,and relieved by endoscopic incision by Holmium:YAG laser.Conclusion Endoscopic management of ureteral fibroepithelial polyps could be a treatment modality with minimal morbidity and good treatment results.