摘要目的 总结原发性输尿管纤维上皮性息肉的诊治策略.方法 回顾性分析1998年1月至2013年3月收治的44例原发性输尿管纤维上皮性息肉患者的临床和病理资料,男27例,女17例.年龄12～67岁,平均37岁.就诊原因:间断腰腹部疼痛28例(63.6％),无痛性肉眼血尿8例(18.2％),肾积水4例(9.1％).病程1周～ 20年,平均4年.38例行CT检查,发现肾积水26例(68.4％)、输尿管肿瘤24例(63.2％).16例行逆行造影检查,发现输尿管充盈缺损13例(81.3％),其中10例(62.5％)充盈缺损呈长条状,怀疑息肉.25例术前行输尿管镜检查,19例发现输尿管长条状肿物.行输尿管局部切除吻合或膀胱再植术28例,输尿管镜下息肉切除术11例,肾输尿管全长切除术5例.结果 40例随访6个月～15年.35例保留肾脏患者均无明显症状,其中31例复查无肾积水和息肉复发;3例轻度肾积水,较术前缓解;1例术后3年因肾积水无功能行肾切除术.结论 原发性输尿管纤维上皮性息肉多见于年轻患者,以间断腰腹痛和肉眼血尿为主要表现,CT和逆行造影检查有助于对疾病的诊断,输尿管镜检查对明确诊断和制定治疗方案、减少误诊非常重要,输尿管镜下息肉切除术是安全有效的微创治疗方法.

abstractsObjective To summarize the diagnosis and treatment strategy of primary ureteral fibroepithelial polyp.Methods The Clinico-pathological data of 44 primary ureteral fibroepithelial polyp cases (27 males and 17 females) treated from Jan.1998 to Mar.2013 were analyzed retrospectively.The mean age was 37 (12-67) years.Patients were admitted with flank-abdominal pain (63.6％),painless gross hematuria (18.2％) and hydronephrosis (9.1％) with a mean history of 4 (1 week-20 years) yrs.CT scan of the 38 cases revealed hydronephrosis (68.4％) and ureter tumor (63.2％).Of the 16 cases with retrograde urography,13 demonstrated filling-defects in ureter (81.3％),among whom,10 revealed long strip-shaped filling-defects suspect of ureter polyp (62.5％).Ureteroscopy was performed in 25 cases and discovered ureter polyp in 19 patients.Partial ureterectomy was performed on 28 patients,endoscopic procedure was performed on 11 cases and the left 5 patients were treated with nephroureterectomy.Results 40 patients were followed-up for 6 mon to 15 years.Of the 35 patients with the kidney reserved,31 were fully recovered with no symptoms and with no hydronephrosis or polyp recurring,3 cases with hydronephrosis were relieved,1 patient lost the affected kidney after 3 years because of severe hydronephrosis.Conclusions Primary ureteral fibroepithelial polyp should be suspected in younger patients with long term intermittent flank or abdominal pain and/or gross hematuria.CT scan and retrograde urography are the main diagnostic imaging studies.Ureteroscopy plays a pivotal role in the diagnosis and decision of treatment strategy,especially to avoid undertaking nephroureterectomy in suspicious of ureteral carcinoma.Resection of the polyp under ureteroscopy is safe and effective.