Johnson G Blake, Grasso Michael
Department of Urology, St Vincent's Hospital, New York Medical College, New York, NY 10011, USA.
Curr Opin Urol. 2005 Mar;15(2):89-93. doi: 10.1097/01.mou.0000160622.13366.a1.
Traditionally, nephroureterectomy has been the treatment of choice for transitional cell carcinoma of the upper urinary tract. In an effort to preserve renal function, conservative therapy has evolved from complex open surgery to minimally invasive ureteroscopic therapy. Considering the relatively recent emergence of ureteroscopic therapy, a review of technical considerations and treatment outcome is timely.
There is emerging evidence that ureteroscopic treatment of low grade upper tract lesions provides an acceptable oncologic result while preserving functioning renal parenchyma. In patients with low grade upper tract urothelial lesions, progression is rarely reported. Ureteroscopy has for over a decade been the premier diagnostic tool, with the actively deflectable flexible instrument being employed to map the entire intrarenal collecting system. Improvements in instrumentation and refinement in technique have broadened the application of the ureteroscope in treating upper urinary tract urothelial tumors.
For low grade lesions, which make up more than 50% of all presentations, ureteroscopic management has proven efficacious. As with similar grade lesions in the bladder, these patients require careful, consistent, and often lifelong follow up as many will develop recurrent lesions throughout the urothelium. Here too, ureteroscopy has a central role in surveillance.
传统上，肾输尿管切除术一直是上尿路移行细胞癌的首选治疗方法。为了保留肾功能，保守治疗已从复杂的开放手术发展到微创输尿管镜治疗。鉴于输尿管镜治疗相对较新出现，对技术要点和治疗结果进行综述很及时。
越来越多的证据表明，输尿管镜治疗低级别上尿路病变在保留有功能的肾实质的同时可提供可接受的肿瘤学结果。在低级别上尿路尿路上皮病变患者中，很少有进展的报道。十多年来，输尿管镜一直是主要的诊断工具，可弯曲的主动偏转器械被用于绘制整个肾内集合系统。器械的改进和技术的完善拓宽了输尿管镜在上尿路尿路上皮肿瘤治疗中的应用。
对于占所有病例50%以上的低级别病变，输尿管镜治疗已被证明是有效的。与膀胱中类似级别的病变一样，这些患者需要仔细、持续且通常是终身的随访，因为许多患者会在整个尿路上皮出现复发性病变。在此，输尿管镜在监测中也起着核心作用。
