膀胱憩室癌5例报告

目的：探讨膀胱憩室癌的临床特征，提高其诊治水平。方法：对5例膀胱憩室癌患者均行CT和膀胱镜检查确诊。3例行根治性膀胱全切、尿流改道手术．2例行膀胱部分切除术。结果：病理诊断移行细胞癌2例，鳞状细胞癌2例，恶性神经鞘瘤1例。3例于术后2个月内死亡，均为非移行性细胞癌；另外2例术后随访10个月，无局部复发和远处转移。结论：CT和膀胱镜检查是确诊膀胱憩室癌的重要方法；膀胱憩室癌的临床分期不同，预后明显不同，非移行细胞癌病理类型有早期浸润行为．预后差。     

膀胱憩室的手术治疗

作者总结３１例膀胱憩室的手术治疗结果，并介绍一种处理巨大膀胱憩室的简易手术。多数憩室继发于膀胱流出道梗阻。憩室内并发肿瘤７例，结石形成９例。膀胱憩室多由膀胱造影或Ｂ超诊断。憩室切除常采用膀胱内外联合入路。本组２６例手术同时处理膀胱出口梗阻和膀胱憩室。获得随访的２３例中，２１例尿路症状消失。７例憩室肿瘤患者中，５例在两年半内死亡，余２例分别存活２年和６年。本组２例巨大膀胱憩室行经膀胱内憩室旷置术，无并发症，膀胱造影无异常。作者认为，膀胱憩室的治疗应依据每个患者的情况而选用不同的手术方式。对位于膀胱后下方，粘连广泛的巨大憩室，宜采用经膀胱内入路憩室旷置术。     

膀胱憩室小细胞癌1例

患者,男,84岁。因间歇无痛性肉眼全程血尿3个月,加重伴乏力,尿痛1周,于2009年6月14日入院。患者3个月前出现肉眼血尿,为全程无痛性,1周前上述症状加重,伴乏力,尿痛,无发热、盗汗、消瘦及腰腹部疼痛。患者既往排尿困难7年,未系统治疗。体检：耻骨上区偏左可触及约8cm×9cm囊性包块,光滑,压痛不明显。肛门指诊前列腺Ⅱ度大,质韧,未触及质硬结节,中央沟消失。     

先天性左心室憩室

总结４例先天性左心室憩室（ＬＶＤ）的外科治疗体会。对２例肌性ＬＶＤ，仅纠治其合并畸形，憩室未予切除；在２例纤维性主动脉瓣下憩室中，１例经假性动脉瘤修补憩室，１例行主动脉瓣替换同时关闭憩室开口。结果除１例经假性动脉瘤修补憩室者，因左冠状动脉损伤术中死亡外，其余３例效果良好。结论认为，肌性ＬＶＤ小而收缩功能好，可仅纠治合并畸形，憩室不予处理；经主动脉径路修补主动脉瓣下ＬＶＤ为一安全可靠的方法     

先天性左心房憩室1例

病儿　男 ,12岁。 1个月前体检发现心脏扩大 ,无症状。查体 :心前区稍饱满 ,心浊音界向左扩大。心率 86次 /ｍｉｎ ,律齐。未闻及病理性杂音。Ｘ线胸片示左心缘明显膨隆。胸部ＣＴ示左侧心包腔内占位性病变。超声心动图左室后壁之后有一约 6 5ｃｍ× 5 8ｃｍ囊性无回声区 ,囊肿包膜光滑完整 ,左室后壁与该无回声区未见异常通道 ,各房室腔大小及瓣膜启闭正常。彩色多谱勒于各瓣膜口未测及异常血流信号。核素心室造影及心肌断层显像示左右心室大小正常 ,左心室旁可见一随时间延长而增大的异常血池影 ;电影显示与左心房出现时序基本一致的血…     

膀胱憩室疝1例

患者　男 ,34岁。因左侧腹股沟包块 2年入院。体查 :左腹股沟部有一约核桃大小包块 ,无疼痛 ,不能还纳。诊断 :左侧腹股沟斜疝。拟行疝高位结扎修补术。当显露“疝囊”时 ,切开后有黄色液体流出。用手指探查 ,发现其与膀胱相通 ,经探查证实疝内容物为膀胱憩室。切除憩室 ,缝合修补膀胱后行疝修补术。术后留置尿管 5ｄ ,痊愈出院。膀胱憩室疝1例@杨兴勇$四川省康定县姑咱人民医院外科!四川康定626001膀胱憩室疝;;病例报告     

膀胱憩室癌11例诊治体会

报告膀胱憩室癌11例,并就其临床症状、诊断及治疗等进行讨论,认为如病人发生血尿合并下尿路梗阻、尿频、脓尿、二次排尿等症状时,应高度怀疑本病;诊断首选膀胱镜检查,B超、CT对肿瘤分期具有重要意义;治疗以膀胱部分切除为主,因憩室癌恶性程度高、预后差,术后应辅以放疗或化疗。     

CT逆行性膀胱造影诊断膀胱憩室

目的探讨CT逆行性膀胱造影诊断膀胱憩室的价值。方法分析7例经手术证实的膀胱憩室患者的影像及临床资料。结果 7例患者均接受CT平扫,2例获得明确诊断。对3例行增强CT扫描,明确诊断2例。4例接受CT逆行性膀胱造影,均获明确诊断。同期对3例行超声检查,明确诊断1例;对4例行膀胱X线造影,明确诊断2例。结论 CT逆行性膀胱造影能准确诊断膀胱憩室,较好地显示膀胱憩室的大小、部位、形态、开口,是诊断膀胱憩室简便有效、经济的检查方法。     

先天性尿道憩室6例报告

目的：总结对先天性尿道憩室的诊治经验。方法：回顾性分析６例本病患儿的临床资料。结果：除１例憩室造口者术后形成尿瘘,经二次尿瘘修补术治愈之外,其余５例均一期行憩室切除加尿道修补术,其中４例痊愈,１例术后发生针孔样尿瘘,１个月后自行愈合。５例获得１～５年随方,均排尿通畅,会阴部包块消失,排尿性膀胱尿道造影结果正常。结论：一期憩室切除加尿道修补是治疗本病的有效方法。     

巨大膀胱憩室癌并多发结石1例

膀胱憩室癌国内报道不多，而巨大膀胱憩室癌伴多发结石更少见。我院近期收治1例，报告如下。     

Congenital bladder diverticula in children

BACKGROUND/PURPOSE: The authors report their experience with the management of congenital bladder diverticula in children. METHODS: The authors reviewed the histories of six boys (mean age, 4.4 years) in whom congenital bladder diverticula was treated from 1980 to 1996. Diverticula were unilateral in four patients and bilateral in two patients. All patients presented recurrent urinary tract infection, and two boys had several episodes of urinary retention. Secondary kidney damage was present in two patients with ureteral obstruction and one with vesicoureteral reflux. Surgical treatment was undertaken in all patients. RESULTS: After surgical treatment, none of the patients has had recurrence of the diverticula, and all remain asymptomatic. CONCLUSIONS: Congenital bladder diverticula have a wide clinical spectrum and could lead to severe kidney damage. Urinary tract infection and urinary retention are the most frequent presentation forms. Surgical treatment should be indicated in all symptomatic cases according to each anatomic and functional situation.     

Congenital bladder diverticula in adult twins.

We present two cases of apparent congenital bladder diverticula in adult twins associated with progressive hearing loss.     

Congenital bladder diverticula causing ureteral obstruction

Two boys with congenital periureteral bladder diverticula without vesicoureteral reflux but with severe hydronephrosis and ureteral obstruction are described. No bladder outflow obstruction was present. Urinary tract infection was the presenting symptom in both boys, and this is the most common presenting symptom of bladder diverticula. Diverticulectomy, ureteral tailoring, and reimplantation were performed. Three different mechanisms are proposed for the association of bladder diverticula and ureteral obstruction: compression of the extravesical ureter against the detrusor by the full, tense diverticulum, fibrosis resulting from peridiverticulitis, or primary hypomuscularity of the ureterovesical junction and distal ureter.     

Surgical management of primary bladder diverticula in children

Purpose

The aim of this study was to review the authors' surgical experience with primary bladder diverticula in the pediatric population, with special attention to associated urinary tract infections and voiding dysfunction.

Methods

A retrospective review yielded 21 pediatric patients with primary bladder diverticula treated surgically over a 13-year span. Patients with secondary diverticula were excluded. Charts were reviewed and patients were contacted in regards to several factors. Diverticula were diagnosed preoperatively by radiography on a voiding cystourethrogram. Diverticula, which were only found intraoperatively and not on VCUG, were not included in the study.

Results

Mean age at presentation was 8.16 years (range of 0.17-12.91 years). The sex predominance was male, 17 (81%) of 21. Mean follow-up was 44.2 months (range of 6-156 months). The diverticula were associated with ureters requiring reimplantation in 15 of 21 patients (72.4%); only 6 (28.6%) of 21 were isolated diverticula. Nineteen (90.5%) of 21 patients presented with infections, and all 19 (100%) have had complete resolution of infections. Of the total, a subset of 6 patients with isolated diverticula and no evidence of reflux had total resolution of their infections. Twelve patients presented with voiding dysfunction. Eight of these 12 patients had improvement of their voiding dysfunction with complete resolution in 2 patients.

Conclusions

In this series, infections were eliminated with surgical excision of the primary diverticula. Surgical repair was also associated with improvement of voiding dysfunction.     

Urinary bladder diverticula and the Ehlers-Danlos syndrome in children

Two large bladder diverticula that induced severe micturition disturbances were surgically removed in a 5-year-old boy with Ehlers-Danlos syndrome (EDS). One year after surgery, a new, asymptomatic diverticulum developed. This case is discussed in the light of nine similar cases that have already been published. It is concluded that EDS diverticula form a distinct group characterized by postoperative recurrence. They are not due to vesicourethral obstruction but probably result from an anomaly of the vesical wall. They are responsible for micturition difficulties and urinary tract infections. Their unavoidable recurrence means that surgery should be restricted only to symptomatic patients.     

儿童先天性膀胱颈梗阻及其诊治

目的：探讨儿童先天性膀胱颈梗阻的临床特点,提高对先天性膀胱颈梗阻的认识。方法：报告2例先天性膀胱颈梗阻患儿诊治资料,复习有关文献。结果：1例运用尿道镜电切,延期输尿管再植,另1例采用开放手术作膀胱颈增生后唇的楔形切除,同时作膀胱与输尿管再植术,随访3～6个月,均取得了满意效果。结论：儿童先天性膀胱颈梗阻是一种少见的儿童下尿路梗阻,以膀胱颈增生的排列紊乱的平滑肌和弹力纤维为病理特点。可以根据其临床特征、膀胱镜、VCUG、VUDS等作出诊断,尿道内窥镜电切术或开放性膀胱颈成形术可获得良好的治疗效果。