目的 探讨膀胱镜在血尿患者膀胱病变诊断中的应用价值，并比较其与超声、CT尿路造影（CTU）、尿液细胞学的诊断效能差异，为临床精准诊疗提供参考。方法 回顾性选取在2020年6月至2025年6月期间本院收治的100例血尿患者作为研究对象，所有患者均 接受膀胱镜检查，以病理检查结果为金标准，分析病变类型分布情况；统计膀胱镜的诊断准确率、灵敏度、特异度；并比较4种检查方法对膀胱肿瘤的检出效能；记录并发症发生情况。结果 100例血尿患者经病理检查确诊：膀胱病变68例，其中膀胱肿瘤23例、膀胱炎26例、膀胱结石12例、膀胱息肉7例；非膀胱源性血尿32例。在膀胱肿瘤检出方面：超声灵敏度34.78%（8/23）、CTU灵敏度47.83%（11/23）、尿液细胞学灵敏度26.09%（6/23），而膀胱镜灵敏度为95.65%（22/23）。肉眼血尿组的膀胱病变检出率和膀胱肿瘤检出率均显著高于镜下血尿组（P<0.05）。经膀胱镜检查诊断：膀胱病变71例，阳性65例，阴性6例；非膀胱病变29例，阴性26例，阳性3例。膀胱镜的灵敏度、特异度和准确度分别为95.59%、81.25%、91.00%；膀胱镜与病理检查的一致性良好（kappa=0.894）。5例患者出现轻微血尿，3例患者出现尿道刺激症状，均在1～2天内自行缓解。无严重感染、膀胱穿孔等严重并发症发生。结论 膀胱镜检查对膀胱病变具有极高的诊断价值，其灵敏度显著优于超声、CTU及尿液细胞学。对于肉眼血尿患者，膀胱镜检查指征明确；对于镜下血尿患者，需结合危险因素综合评估检查必要性，避免过度医疗。
Objective This study explores the application value of cystoscopy in the diagnosis of bladder lesions in patients with hematuria, and compares its diagnostic efficacy with that of ultrasound, CT urography (CTU), and urine cytology, aiming to provide a reference for clinical precise diagnosis. Methods: A total of 100 patients with hematuria admitted to our hospital from June 2020 to June 2025 were retrospectively selected as the research subjects. All patients underwent cystoscopy. Taking the pathological examination results as the gold standard, the distribution of lesion types was analyzed, and the diagnostic accuracy, sensitivity, specificity of cystoscopy. Compare the detection efficacy of the four examination methods for bladder tumors; record the occurrence of complications. Results: Among 100 patients with hematuria, pathological examination confirmed that 68 cases had bladder lesions, including 23 cases of bladder tumors, 26 cases of cystitis, 12 cases of bladder stones, and 7 cases of bladder polyps. There were 32 cases of non-bladder origin hematuria. In terms of bladder tumor detection: the sensitivity of ultrasound was 34.78% (8/23), that of CTU was 47.83% (11/23), that of urine cytology was 26.09% (6/23), and that of cystoscopy was 95.65% (22/23). The detection rates of bladder lesions and bladder tumors in the group with gross hematuria were significantly higher than those in the group with microscopic hematuria (P < 0.05). Diagnosis by cystoscopy: 71 cases of bladder lesions, 65 positive cases and 6 negative cases. There were 29 cases of non-bladder lesions, including 26 negative cases and 3 positive cases. The sensitivity, specificity and accuracy of cystoscopy were 95.59%, 81.25% and 91.00% respectively. The consistency between cystoscopy and pathological examination was good (kappa=0.894). Five patients presented with mild hematuria and three patients had urethral irritation symptoms, all of which relieved spontaneously within 1 to 2 days. No serious complications such as severe infection or bladder perforation occurred. Conclusion: Cystoscopy has extremely high diagnostic value for bladder lesions, with its sensitivity significantly superior to ultrasound, CTU and urine cytology. For patients with gross hematuria, the indication for cystoscopy is clear; for those with microscopic hematuria, the necessity of the examination should be comprehensively evaluated based on risk factors to avoid excessive medical treatment.
