[Application of narrow-band imaging flexible ureteroscopy in the diagnosis, treatment and follow-up of upper tract urothelial carcinomas].

Objective: To investigate application value of narrow-band imaging (NBI) flexible ureteroscopy in the diagnosis, treatment and follow-up of upper urinary tract transitional carcinomas (UTUC). Methods: From June 2015 to June 2017, 16 patients of UTUC were treated by flexible ureteroscopy with white light (WLI) and NBI at Department of Urology, Peking University Third Hospital , including 10 females and 6 males. The age of patients ranged from 43 to 84 years (average 68.9 years). There were 54 cases, including 16 cases with first-suspicion of cancer, and 38 cases with known of UTUC as follow-up. Full renal collecting system examination was performed first under WLI and then under NBI by a single urologist, using the URF-V digital flexible ureteroscope. Then number of tumors visualized by WLI and NBI flexible ureteroscopy were imaged, recorded, and then biopsied or subsequently treated by holmium laser resection with pathological examination. The diagnosis results of NBI flexible ureteroscopy were compared with WLI flexible ureteroscopy results. All the patients underwent 2(nd)-look ureteroscopy after 4 to 6 weeks since the first ureteroscopy, and after that follow-up flexible ureteroscopy was every 6 months. Results: All the operations of 54 cases were successful. One case was treated with flexible ureteroscopy and percutaneous nephroscopy to treat the renal pelvis tumors, duo to the multiple and much larger tumors. Subjectively, NBI significantly provided a much clearer view of the tumors, especially their limits and vascular architecture. Objectively, 4 additional tumors (11.5%), as well the extended limits of 3 tumors (8.5%) were detected by NBI when findings by WLI were considered normal. The rate of diagnosis of tumors raised 20.0%. Conclusions: Compared with WLI, NBI flexible ureteroscopy provided even more image of UTUC especially their border between tumor tissue and normal tissue. NBI improved the detection of UTUC over standard WLI with higher rate of diagnosis or lower rate of missed diagnosis.目的：评估窄带成像(NBI)技术结合输尿管软镜在上尿路尿路上皮肿瘤诊断、治疗和术后监测随访中的应用价值。 方法：回顾性分析2015年6月至2017年6月北京大学第三医院泌尿外科收治的16例上尿路尿路上皮肿瘤患者资料，患者均接受NBI技术结合输尿管软镜探查、钬激光肿瘤切除术。男性6例，女性10例，年龄68.9岁(范围：43～84岁)。共实施手术54例次，其中首次手术16例次，复查手术38例次。置入电子输尿管软镜导入鞘后，观察肾盂及各个肾盏，在传统白光和NBI技术辅助下寻找肿瘤位置，用200 μm光纤以0.5～0.8 J、20 Hz、10～16 W行肿瘤切除，以网篮将切下组织移位或清除取出。在切除肿瘤前及切除肿瘤后，利用NBI技术辨别肿瘤及肿瘤边缘。术后4～6周行二次输尿管软镜下切除术，每半年行一次输尿管软镜探查术。 结果： 54例次手术均获得成功，其中1例因肾盂内肿瘤多发，肿瘤较大，联合经皮肾镜处理肾盂肿瘤。NBI技术能够提供更加清晰的尿路上皮肿瘤的图像，特别是肿瘤组织与正常黏膜的边界。共发现肿瘤35个，其中4个(11.5%)仅NBI技术可检测到，3个(8.5%)仅NBI技术可确定肿瘤卫星灶，NBI可以将尿路上皮肿瘤的检出率提高20.0%。随访1～25个月，5例患者术后复查局部肿瘤复发，其中1例患者合并患侧背部皮下和肾周肿瘤转移；1例患者再发膀胱肿瘤。 结论：与传统白光输尿管软镜相比，NBI技术结合输尿管软镜可以更准确显示肿瘤组织与正常肾盂或输尿管黏膜的边界，明显改善图像质量，并提高上尿路尿路上皮肿瘤的检出率。.