Bagley D H
Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
J Clin Laser Med Surg. 1998 Feb;16(1):55-9. doi: 10.1089/clm.1998.16.55.
To summarize the present status of ureteroscopic laser treatment of upper urinary tract tumors.
Small diameter rigid and flexible ureteroscopes can provide convenient access to the upper urinary tract. The small diameter of the instruments and the working channels are ideally suited for the placement of laser fibers as an intraluminal ablative technique.
The authors reviewed the literature and their own experience with laser treatment of upper tract tumors for the description of instruments, techniques, and the results achieved.
At least 12 reports have presented the results after using lasers for treating upper tract tumors. The Nd:YAG laser has been used in most series but more recently, the holmium:YAG laser has become available. Each laser has particular advantages and each can be delivered along the same low water content quartz fibers. Less scarring with stricture formation has been reported after use of the laser versus electrofulguration. Among the series reported, local recurrences occurred in 33% of patients with renal pelvic tumors or ureteral tumors. In the authors' experience, the holmium:YAG laser was most frequently used and the combination of holmium and Nd:YAG was nearly as common. The Nd:YAG was used alone in less than 10% of patients.
The ureteroscopic treatment of upper tract transitional cell carcinoma is a reasonable alternative to surgical removal in many patients. It provides a major advantage in patients with specific indications for conservative therapy and may be a reasonable elective therapy in others with small, low grade, tumors. The holmium laser alone or in combination with the Nd:YAG laser has become our primary mode of therapy.
总结输尿管镜激光治疗上尿路肿瘤的现状。
小口径硬性和软性输尿管镜能够方便地进入上尿路。器械及工作通道的小口径非常适合放置激光光纤，作为一种腔内消融技术。
作者回顾了文献及自身应用激光治疗上尿路肿瘤的经验，以描述所用器械、技术及取得的结果。
至少有12篇报告介绍了使用激光治疗上尿路肿瘤后的结果。大多数系列研究使用的是钕：钇铝石榴石激光，但最近钬：钇铝石榴石激光也已可用。每种激光都有其独特优势，且均可通过相同的低含水量石英光纤传输。与电灼术相比，使用激光后报告的瘢痕形成及狭窄较少。在报告的系列研究中，肾盂肿瘤或输尿管肿瘤患者的局部复发率为33%。根据作者的经验，最常使用的是钬：钇铝石榴石激光，钬激光与钕：钇铝石榴石激光联合使用的情况也很常见。单独使用钕：钇铝石榴石激光的患者不到10%。
在许多患者中，输尿管镜治疗上尿路移行细胞癌是手术切除的合理替代方法。对于有保守治疗特定指征的患者，它具有主要优势，对于其他患有小的、低级别肿瘤的患者，也可能是一种合理的选择性治疗方法。单独使用钬激光或与钕：钇铝石榴石激光联合使用已成为我们的主要治疗方式。
