壁间型膀胱平滑肌瘤十例患者诊治经验的初步探讨

目的通过对壁间型膀胱平滑肌瘤的诊疗进行回顾性分析,初步探讨其临床诊疗方式。方法回顾性分析2010年1月至2019年1月于徐州医科大学附属医院泌尿外科行手术治疗壁间型膀胱平滑肌瘤10例患者资料。其中男性1例,女性9例,年龄33~51(44±6)岁。其中5例患者以膀胱刺激症状为主要临床表现,1例患者以下腹痛为主要表现,还有4例患者无明显临床症状,患者发病时间1周至2年,平均4.9个月。患者泌尿系彩超检查发现膀胱壁上形态规则、表面覆盖黏膜高回声的低回声包块。CTU检查为膀胱壁均质样实性肿块,边界清楚、光滑,无侵蚀表现,膀胱壁走形自然,且壁周脂肪间隙清晰,膀胱内可见充盈缺损。膀胱镜检查可见瘤体表面黏膜常完整连续,可见局部稍向膀胱内隆起。根据患者肿瘤部位、大小,10例患者分别采用经尿道平滑肌瘤剜除术和腹腔镜下平滑肌瘤剜除术,3例患者术中冰冻切片示:膀胱平滑肌瘤。结果10例患者中有临床症状者:其中5例以膀胱刺激症状为主诉的患者术后症状明显缓解,表现为下腹部疼痛症状的患者术后腹痛症状消失,所有患者术后均未发生并发症,术后随访4~24个月(平均16个月)均未见肿瘤复发且未诉漏尿等常见并发症。结论泌尿系彩超,CTU等影像学检查与膀胱镜相结合是诊断壁间型膀胱平滑肌瘤的主要手段,经尿道肿瘤剜除术、腹腔镜下肿瘤剜除术是治疗壁间型膀胱平滑肌瘤安全有效的手术方式且预后较好。

Clinical analysis of intermural bladder leiomyoma:Ten cases report

Objective To explore the diagnosis and treatment of interstitial bladder leiomyoma.Methods A retrospective analysis of 10 patients with interstitial bladder leiomyoma enucleation treated by the same group from January 2010 to January 2019 in Affiliated Hospital of Xuzhou Medical University was performed.The mean age was(44±6)years(range 33-51).Clinical manifestation included irritative bladder 5 cases,the symptoms of lower abdominal pain in 1 and absence of symptoms in 4.The mean course was 4.9 months(range 1 week-2 years).Color Doppler ultrasonography of the urinary system in 10 patients revealed a hypoechoic mass with a regular morphology on the bladder wall and a hyperechoic surface covering the mucosa.The CTU examination showed a homogenous solid mass in the bladder wall with a well-defined,smooth border and no erosive appearance,a naturally shaped bladder wall with a clear peri-mural fat space and a filling defect in the bladder.Cystoscopy showed that the surface mucosa of the tumor was often intact and continuous,showing a slight local bulge.According to the patient's tumor location and size,ten patients were treated with transurethral leiomyoma enucleation and laparoscopic leiomyoma enucleation,respectively.Intraoperative frozen section showed leiomyoma of the bladder in three patients.Results Among the 10 patients who had clinical symptoms:5 of them had bladder irritation as the main complaint.Postoperative symptoms were significantly relieved,and those with lower abdominal pain symptoms disappeared.None had complications.None had tumor recurrence or complained of urinary fistula or other common complications during postoperative follow-up of 4-24 months(16.43 months on average).Conclusion The combination of color Doppler ultrasonography,CTU and cystoscopy are the main method to diagnose intramural bladder leiomyoma.Transurethral leiomyoma enucleation and laparoscopic leiomyoma enucleation is a safe and effective surgical technique for treating subserosal bladder leiomyoma with excellent results.