膀胱良性肿瘤30例的诊断及治疗

目的探讨膀胱良性肿瘤的诊断及治疗方法。方法对30例膀胱良性肿瘤病例进行回顾性分析。结果 30例术前依靠B超、尿路造影、CT、膀胱镜检查加活检及术后病理明确诊断为乳头状瘤6例（伴非典型增生2例）,内翻性乳头状瘤16例（伴非典型增生5例）,平滑肌瘤7例,嗜铬细胞瘤1例。视肿瘤具体情况分别采取TURBT术、膀胱部分切除术、膀胱肿瘤剜除术,术后定期膀胱镜检查,随访3个月～2a,未见复发病例。结论膀胱良性肿瘤病理类型较多,术前诊断主要依靠影像学检查及膀胱镜检查,B超为重要的筛查方法 ,而确诊则有赖于术后的病理检查,乳头状瘤及内翻性乳头状瘤治疗首选TURBT术,平滑肌瘤则常需行膀胱部分切除术。对伴有非典型增生病例,术后常规采用规则膀胱内灌注化疗,可降低肿瘤复发率及防止癌变。     

膀胱良性肿瘤30例的诊断及治疗

目的 探讨膀胱良性肿瘤的诊断及治疗方法.方法 对30例膀胱良性肿瘤病例进行回顾性分析.结果 30例术前依靠B超、尿路造影、CT、膀胱镜检查加活检及术后病理明确诊断为乳头状瘤6例(伴非典型增生2例),内翻性乳头状瘤16例(伴非典型增生5例),平滑肌瘤7例,嗜铬细胞瘤1例.视肿瘤具体情况分别采取TURBT术、膀胱部分切除术、膀胱肿瘤剜除术,术后定期膀胱镜检查,随访3个月～2a,未见复发病例.结论 膀胱良性肿瘤病理类型较多,术前诊断主要依靠影像学检查及膀胱镜检查,B起为重要的筛查方法,而确诊则有赖于术后的病理检查,乳头状瘤及内翻性乳头状瘤治疗首选TURBT术,平滑肌瘤则常需行膀胱部分切除术.对伴有非典型增生病例,术后常规采用规则膀胱内灌注化疗,可降低肿瘤复发率及防止癌变.     

2μm激光、钬激光和经尿道膀胱肿瘤切除术治疗非肌层浸润性膀胱癌的比较研究

目的：比较2μm激光、钬激光与经尿道膀胱肿瘤切除术(transurethral resection of the bladder tumor,TURBT)治疗非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)的有效性和安全性。方法：2011年6月至2013年6月期间,210例初诊为NMIBC患者被随机分到2μm激光手术组(n=70)、钬激光手术组(n=70)和TURBT手术组(n=70),记录手术时间、相关并发症、术后膀胱冲洗情况、留置导尿时间、住院时间。术后随访2年,定期行表柔比星膀胱灌注化疗和膀胱镜检查,记录膀胱肿瘤复发情况。结果：所有患者均顺利接受相应手术,2μm激光组、钬激光组和TURBT组的平均手术时间和输血率无统计学差异(P>0.05),TURBT组术中闭孔神经反射和膀胱穿孔发生率、术后需要膀胱冲洗病例、留置导尿时间、住院时间均高于2μm激光组与钬激光组,差异有统计学差异(P<0.05),且2μm激光组与钬激光组之间比较无明显差异。术后两年的随访研究中,共有24名患者失访,三组患者肿瘤复发率无统计学差异(P>0.05)。结论：2μm激光和钬激光在治疗NMIBC上优于传统的TURBT,2μm激光与钬激光两者之间临床疗效比较无明显差异。且TURBT、2μm激光和钬激光在术后肿瘤复发方面并无差异,下一步需要更多的病例数和更长的随访时间来验证本研究结果。     

膀胱良性肿瘤30例的诊断及治疗

目的探讨膀胱良性肿瘤的诊断及治疗方法。方法对30例膀胱良性肿瘤病例进行回顾性分析。结果 30例术前依靠B超、尿路造影、CT、膀胱镜检查加活检及术后病理明确诊断为乳头状瘤6例（伴非典型增生2例）,内翻性乳头状瘤16例（伴非典型增生5例）,平滑肌瘤7例,嗜铬细胞瘤1例,视肿瘤具体情况分别采取TURBT术、膀胱部分切除术、膀胱肿瘤剜除术,术后定期膀胱镜检查,随访3个月～2a,未见复发病例。结论膀胱良性肿瘤病理类型较多,术前诊断主要依靠影像学检查及膀胱镜检查,B超为重要的筛查方法,而确诊则有赖于术后的病理检查,乳头状瘤及内翻性乳头状瘤治疗首选TURBt术,平滑肌瘤则常需行膀胱部分切除术。对伴有非典型增生病例,术后常规采用规则膀胱内灌注化疗,可降低肿瘤复发率及防止癌变。     

膀胱憩室癌1例报告及文献回顾

目的:提高膀胱憩室癌的诊断与治疗水平.方法:报告一例膀胱憩室癌并文献分析,患者,男, 56岁,因"尿频、排尿不畅3个月,加重1个月"入院,术前超声及盆腔CT增强提示膀胱左侧壁多发憩室.结果:入院后行膀胱镜检查,术中见其中最大憩室颈部新生物,宽蒂,大小约1 cm,呈菜花样改变,表面有钙化坏死,活检提示为膀胱移行上皮癌,故行膀胱憩室切除及膀胱部分切除术,术后病理为浸润性膀胱尿路上皮癌.结论:膀胱憩室癌是属于膀胱肿瘤的一种,病理学类型相对复杂,目前诊断方法主要是影像学、内镜检查及病理学检查,治疗一般以外科手术为主,手术方式有经尿道手术、膀胱部分切除术及膀胱根治性切除术,手术方式的选择依据肿瘤的病理学类型及临床分期而定.     

膀胱癌经尿道电切除术后吡柔比星膀胱灌注预防复发的临床观察

目的探讨膀胱灌注吡柔比星（THP）预防浅表性膀胱癌术后复发的安全性及疗效。方法对83例浅表性膀胱癌患者行经尿道膀胱肿瘤电切术（TURBT）,术日及术后1周开始用THP（30mg／40m1）进行膀胱内定期灌注,每次药物在膀胱内保留30～60min,每周1次,连续8次,以后每月1次,连续10次,并随访18～45个月。结果83例患者均未见明显全身性药物不良反应,仅15例出现轻微膀胱刺激症状。结论膀胱灌注THP预防浅表性膀胱癌术后复发的疗效确切,不良反应小,安全性好,是较理想的膀胱灌注化疗药物。     

闭孔神经阻滞在经尿道膀胱肿瘤切除术的应用进展

闭孔神经阻滞主要用于防止在经尿道膀胱肿瘤切除术中大腿内收肌收缩,对于髋、膝关节手术也有良好的镇痛效果,甚至可以有效缓解截瘫、多发性硬化或脑性麻痹患者髋关节内收肌持续痉挛状态。近年来,ONB技术在TURBT中得到了越来越广泛应用,相继有文献报道经典入路、腹股沟血管旁入路、经耻骨上膀胱穿刺入路不同的ONB入路,但目前尚无三种ONB入路技术优缺点综合比较的研究。不同麻醉方式联合应用ONB也是近些年的研究热点,本文将从闭孔神经的解剖学基础、不同入路的闭孔神经阻滞的优缺点、不同麻醉方式联合ONB的效果研究三方面作一综述,阐明目前存在的问题及研究进展。     

pT1期膀胱尿路上皮癌的病理诊断及分期

膀胱尿路上皮癌的分期是最重要的预后因子。WHO将浸润性膀胱尿路上皮癌定义为肿瘤侵透基底膜。膀胱癌TNM分期系统（2002）将膀胱的pT1期肿瘤定义为肿瘤浸润固有膜,但未侵及肌层。尽管临床上常将pT1和pTa期（非浸润性肿瘤）合称为“浅表性”膀胱肿瘤,但pT1期肿瘤的预后要比pTa期差,因此正确诊断pT1期肿瘤对于选择治疗方案和估计预后非常重要。[第一段]     

浸润性膀胱癌保留膀胱综合治疗的短期疗效分析

目的:探讨T2N0M0 、T3N0M0原发性浸润性膀胱癌三种不同治疗方案的近期临床疗效.方法:134例原发性浸润性膀胱癌患者,按术式分为3组,单纯治疗组(S组) 56例行单纯保留膀胱手术,术后常规行丝裂霉素或羟基喜树碱膀胱灌注6个月以上,其中T2N0M0 28例,T3N0M0 28例;综合治疗(I组) 37例行保留膀胱手术、术后行静脉吉西他滨和顺铂化疗,并常规行丝裂霉素或羟基喜树碱膀胱灌注6个月以上,其中T2N0M0 16例,T3N0M0 21例;根治组(R组)41例行根治性手术,其中T2N0M0 20例,T3N0M0 21例.比较3组患者的三年总体生存率以及相同临床分期患者的三年生存率.结果:S组三年总体生存率为39.29%,T2N0M0患者三年生存率为42.86%,T3N0M0为39.26%;I组三年总体生存率为70.27% 、T2N0M0患者三年生存率为75.00%、T3N0M0为66.67% ;R组三年总体年生存率为75.61%,T2N0M0患者三年生存率为80.00%,T3N0M0为71.24%.S组与I组间三年生存率比较差异有统计学意义(P＜0.05),I组与R组间比较差异无统计学意义(P＞0.05).结论:T2N0M0 、T3N0M0临床分期的原发性浸润性膀胱癌患者,综合治疗与根治治疗近期临床疗效无统计学差异.因此建议采用保留膀胱的综合方法治疗,以提高患者生活质量.     

膀胱全切、Roux—y乙状结肠新膀胱术在女性膀胱癌治疗中的应用

目的：评价膀胱全切、Roux-Y乙状结肠新膀胱尿流改道术治疗女性浸润性膀胱癌的临床效果。方法：采用膀胱全切、Roux—Y乙状结肠新膀胱术治疗女性膀胱癌患者12例。术中取直肠腹膜反折以上20cm处切断乙状结肠,近端与直肠在腹膜反折上行乙状结肠-直肠Y式端侧吻合,远端去管化后,构建一球形新膀胱。结果：随访3—96个月,平均36个月。未见肿瘤复发。术后新膀胱容量约300ml,术后3个月平均405ml,1年后平均456ml。无尿失禁发生。术后尿动力学检查,充盈期膀胱压力（39．2±10．8）cmH2O、最大尿流率（34．7±8．9）ml／s,排泄后残留尿量是0ml。7例术后3年行尿路造影示新膀胱形态良好,无输尿管返流及上尿路扩张。结论：Roux—Y乙状结肠新膀胱尿流改道术治疗女性浸润性膀胱癌患者疗效好,并发症少,肿瘤复发率低,术后排尿和控尿功能满意。     

Urinary bladder adenocarcinoma arising in a spina bifida patient

Urinary bladder adenocarcinomas are rare malignancies accounting for approximately 2.5% of all urothelial neoplasms. Intestinal metaplasia of the urothelium indicates the presence of intestinal-type goblet cells and was generally observed to coexist with or to precede the diagnosis of bladder adenocarcinomas. Controversy continues of whether intestinal metaplasia is an acquired precancerous lesion, secondary to different insults to the urothelium, or a concomitant lesion in glandular carcinogenesis. Patients with neurogenic bladders are particularly at risk for developing bladder cancer, mostly squamous cell carcinoma and rarely adenocarcinoma. In these patients, chronic irritation of the urothelium as well as long-term indwelling urinary catheters were the most significant risk factors. Spina bifida is a congenital developmental abnormality that may result in neurogenic bladder. There is only one previously reported case of urothelial carcinoma with associated squamous metaplasia of the bladder occurring in a spina bifida patient. We report the first case of bladder adenocarcinoma associated with intestinal metaplasia occurring in a spina bifida occulta patient. The patient had a complicated clinical course and suffered recurrent urinary tract infections, renal calculi, and urinary incontinence and was managed with intermittent as well as indwelling catheterization.     

Primary adenocarcinoma of the bladder: a rare primary bladder tumour type

Primary bladder adenocarcinoma is rare and metastatic or locally invasive adenocarcinomas from other organs are more frequently seen within the bladder. Here we present a 61-year-old patient with an adenocarcinoma within the bladder neck. It was a diagnostic challenge to differentiate between primary bladder adenocarcinoma, metastatic colorectal adenocarcinoma, and prostatic adenocarcinoma. After extensive immunohistochemistry the diagnosis of primary bladder adenocarcinoma was made. We discuss how to come to this diagnosis and what immunohistochemistry approaches can be taken to differentiate it from other adenocarcinomas.     

Congenital absence of the gall bladder

Summary Congenital absence of the gall bladder is an extremely rare embryological aberration with a reported incidence ranging between 0.013 and 0.075%. This report, the first from South Africa, discusses 2 cases of gall bladder agenesis, bringing to 413 the number of cases reported in the literature. In confirming the diagnosis of an agenesis of the gall bladder, it is necessary to exclude the abnormal locations which are intrahepatic, retrohepatic, on the left side, or within the lesser omentum or falciform ligament and retroperitoneal. Patients with gall bladder agenesis are classified into 3 categories: i) Multiple foetal anomaly (12.9%), ii) Asymptomatic (31.6%) and iii) Symptomatic (55.6%). Notwithstanding current diagnostic modalities, this rare condition may still present a dilemma to the abdominal surgeon. Agenesis of the gall bladder is a well-recognised but uncommon congenital abnormality. With the advent of minimal access surgery laparotomy may be avoided as the condition, when suspected, may be confirmed by ERCP and CT scan.

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Absence congénitale de la vésicule biliaire

Résumé L'absence congénitale de la vésicule biliaire est une malformation dont l'incidence est évaluée de 0,013 à 0,075 %. Nous rapportons deux observations d'agénésie de la vésicule biliaire, représentant les premiers cas de l'Afrique du Sud, nous les confronterons au 413 cas de la littérature. Pour confirmer le diagnostic d'agénésie de la vésicule biliaire, il est nécessaire d'exclure les localisations vésiculaires anormales, soit intra-hépatiques, soit rétro-hépatiques, soit dans le foie gauche, soit à l'intérieur de l'omentum ou du ligament falciforme, voire même rétro-péritonéales. Les patients porteurs d'agénésie de la vésicule biliaire sont classés en trois catégories : 1) Sujets porteurs de multiples anomalies foetales (12,9 %) 2) Sujets asymptômatiques (33,6 %) 3) Sujets avec manifestations cliniques (55,6 %). Néanmoins, les modalités diagnostiques habituelles peuvent, dans de rares conditions, se présenter dans le cadre d'une urgence chirurgicale abdominale. L'agénésie de la vésicule biliaire est une malformation bien connue, mais reste une anomalie rare. Avec l'avènement des abords chirurgicaux à minima, la laparotomie peut être évitée à condition que dans les cas suspectés, on réalise une exploration par endoscopie rétrograde des voies biliaires et pancréatiques (ERCP) et un scanner abdominal.

     

Pregnancy after laparoscopic partial cystectomy for bladder endometriosis

We report a case of partial laparoscopic cystectomy in a 31-year-oldinferile patient presenting vesical endometriosis. This patienthad suffered severe dysmenorrhoea for 10 years previously togetherwith repeated episodes of urinary infection, mostly occurringduring the menstrual period. A diagnostic laparoscopy performedin another centre diagnosed a stage IV endometriosis. Gonadotrophin-releasinghormone agonists were prescribed for 9 months. After failureof this treatment, the patient came to consult us. A solid massin the left supratrigone was detected by pelvic ultrasonographyand confirmed by cystoscopy. Transurethral resection was carriedout. A recurrence of the symptoms 9 months later prompted operativelaparoscopy under cystoscopic control. This confirmed recurrenceof a 3.5 cm endometriotic nodule. Laparoscopic partial cystectomywas performed using the monopolar electrode. The bladder wasthen sutured via laparoscopy. No complications occurred. Nopostoperative treatment was given. Second-look cystoscopy 2months later revealed that healing was perfect. Eight monthslater, the patient is well and has a normal intra-uterine pregnancy.     

米酵菌酸对培养人膀胱癌细胞超微结构的影响

目的：探讨米酵菌酸对人膀胱癌细胞毒性、杀伤作用及其超微结构的影响。方法：将不同浓度的米酵菌酸加入培养的人膀胱癌细胞，24h后，用光镜、透射电子显微镜分析其形态学改变。结果：光镜下可见米酵菌酸低浓度组细胞体积变小，核浆比增大，培养液中死亡细胞增多；高浓度组细胞体积进一步变小，核浆比进一步增大，细胞生长受到显著抑制。电镜下多数线粒体嵴断裂、空泡样变和髓样变;核染色质边集，核周隙增宽；粗面内质网脱颗粒。结论：米酵菌酸对人膀胱癌细胞形态及超微结构有显著影响。     

Chondroma of the bladder

 This case report describes a chondroma of the bladder in a 63-year-old woman with clinical complaints of pain in the left fossa iliaca. The lesion was a tumour with a lobulated growth pattern composed of chondrocytes embedded in a chondroid matrix. Neither mitotic figures nor increased cellularity were present. Nuclei were inconspicuous. Immunohistochemical examination showed reactivity for S100 and vimentin. Received: 22 April 1997 / Accepted: 25 August 1997     

Shortening induced deactivation in the guinea-pig urinary bladder

Shortening induced deactivation, the depressant effect of active muscle shortening on the subsequently measured isometric force, has been shown in smooth muscle strips and rings. The guinea-pig bladder permits the investigation of this phenomenon in a whole organ preparation. Previous work in our laboratory showed that shortening of the in vitro guinea-pig detrusor muscle had a depressant effect on the isovolumetric pressure that could be generated immediately afterwards. To test the hypothesis that this was caused by deactivation, the effects of active and passive detrusor shortening on the subsequently measured isovolumetric pressure were compared. The isovolumetric pressures measured after 5 min periods of recovery were taken as control values. It was found that the isovolumetric pressure after passive shortening was 7% smaller than the isovolumetric pressure without preceding shortening. This difference was ascribed to viscoelastic relaxation during shortening. Active shortening had an additional 8% depressant effect on isovolumetric pressure compared with passive shortening. The effects of active and passive shortening differed significantly. It was concluded that shortening induced deactivation in the guinea-pig urinary bladder smooth muscle in toto can be considered proven. The fact that deactivation is shown both by striated and smooth muscle preparations is in line with the assumption that it is caused by reduced actin-myosin interaction. The hypothesis that (in striated muscle) the latter is effected by a decrease in troponin–calcium binding, however, needs reconsideration.