膀胱嗜铬细胞瘤的诊断及手术治疗

目的探讨膀胱嗜铬细胞瘤的诊断及手术治疗方法。方法回顾性分析2003年5月—2010年10月5例膀胱嗜铬细胞瘤的诊治过程。术前均行超声、CT、膀胱镜及儿茶酚胺和香草基扁桃酸检查,5例术前均获得定位及定性诊断。所有病例术前准备10～14 d后行开放膀胱部分切除术,其中1例行输尿管膀胱再植术。结果 5例术后均恢复良好,术后病理均明确诊断,无恶变;术后随访1～7年,血压正常,无肿瘤复发。结论超声、CT、膀胱镜是膀胱嗜铬细胞瘤最主要的定位诊断,儿茶酚胺和香草基扁桃酸是最主要的定性诊断;手术是治疗膀胱嗜铬细胞瘤的最有效方法,围术期处理是手术成功的基础,开放膀胱部分切除术仍是嗜铬细胞瘤治疗的首选术式。     

膀胱肿瘤患者行全膀胱切除回肠代膀胱手术的护理

目的 提高全膀胱切除回肠代膀胱术的护理效果.方法 对36例膀胱肿瘤患者实施全膀胱切除回肠代膀胱术和综合护理措施.结果 36例手术切口全部Ⅰ期愈合,回肠代膀胱腹壁造口血循环佳,引流通畅,有1例出院后发生造瘘口周围皮肤湿疹,经造口护理后痊愈.结论 术前做好肠道清洁与肠道灭菌准备,术后注重引流管的护理,注意并发症的观察,早期进行代膀胱的功能锻炼,取得了满意的治疗和护理效果.     

经尿道膀胱肿瘤电切术190例护理体会

目的探讨经尿道膀胱肿瘤电切术的护理对策。方法对近3年来190例经尿道膀胱肿瘤电切术患者的护理措施和经验。结果所有患者均手术成功,术后恢复快,无并发症等顺利出院。结论做好术前术后护理对经尿道膀胱肿瘤电切术患者尤为重要。     

1例全膀胱切除原位回肠代膀胱术的护理体会

目的 介绍1例膀胱全切除,原位回肠代膀胱术治疗膀胱肿瘤患者的护理体会.病历资料:患者,男,58岁术后有不同程度的尿失禁,经膀胱机能训练后能自行解尿.结论 膀胱全切除,原位回肠代膀胱术是深受膀胱肿瘤患者欢迎的一种术式.术后各引流管的护理,膀胱机能的训练是本手术护理的关键,有助于预防和减少并发症,提高手术的效果.     

膀胱肿瘤经尿道气化电切术后膀胱灌注化疗的护理

目的总结膀胱肿瘤气化电切术后丝裂霉素膀胱灌注化疗,预防肿瘤复发的的护理经验。方法对2005年7月至2008年7月76例浅表膀胱肿瘤行气化电切术,术后进行膀胱灌注的患者实施心理护理和治疗前后的护理。结果所有手术患者坚持完成全程化疗,调查肿瘤复发率,观察治疗的有效率。结论良好的心理护理及膀胱灌注前后的护理,可有效防止并发症的发生,使患者顺利完成全程化疗,从而预防膀胱肿瘤术后复发,提高患者的生活质量。     

膀胱嗜铬细胞瘤的临床诊治体会

目的：探讨膀胱嗜铬细胞瘤的诊断及手术治疗方法。方法：回顾性分析2007年5月-2012年5月32例膀胱嗜铬细胞瘤的诊治过程。术前均行超声、CT、膀胱镜及儿茶酚胺（CA）和香草基扁桃酸（VMA）检查,32例术前均获得定位及定性诊断。所有病例术前准备10-14d后,行开放膀胱部分切除术,其中1例行输尿管膀胱再植术。结果：32例术后均恢复良好,术后病理均明确诊断,无恶变;术后均随访1-7年,血压正常,无肿瘤复发。结论：超声、CT、膀胱镜是最主要的定位诊断,CA和VMA是最主要的定性诊断;手术是治疗膀胱嗜铬细胞瘤的最有效方法,围手术期处理是手术成功的基础;开放膀胱部分切除术仍是嗜铬细胞瘤治疗的首选术式。     

膀胱全切回肠原位膀胱术16例的围手术期护理体会

目的：探讨膀胱全切回肠代膀胱术患者的护理对策,以降低术后并发症,促进术后患者康复。方法：对16例膀胱全切回肠原位膀胱术患者施行有计划、有目标的护理措施,术前重视心理护理,加强术前指导及术前准备,术后密切观察病情及生命体征变化,做好术后并发症的观察和护理。结果：16例膀胱全切回肠代膀胱术患者术后顺利康复,无并发症发生。结论：对膀胱全切回肠代膀胱术后患者实施正确的围手术期护理方法,可以有效减少术后并发症,降低死亡率。     

心理护理干预对经尿道膀胱肿瘤电切术患者的影响

目的：观察心理护理干预在经尿道膀胱肿瘤电切术患者（TURBT）围术期的效果.方法：选择近一年来经尿道膀胱肿瘤电切术患者共80例,分为两组,对照组40 例患者采用常规护理,观察组40例在常规护理的基础上加强心理干预.比较分析两组患者的效果.结果：两组患者手术均成功,但两组患者的最终SAS和SDS评分差异有统计学意义（P〈0.05）.结论：经尿道膀胱肿瘤电切术是治疗浅表膀胱肿瘤的首选,而做好术前术后心理护理对经尿道膀胱肿瘤电切术患者尤为重要.     

浅谈整体护理在前列腺术前及术后膀胱痉挛预防及治疗中的作用

目的：探讨整体护理在前列腺术前及术后膀胱痉挛预防及治疗中的作用。方法：研究对象为自2006年以来在本院行前列腺手术的60例患者。结果：整体护理干预明显降低前列腺手术术后膀胱痉挛的发生率,并且对于术后并发膀胱痉挛的患者,护理干预具备辅助性治疗作用。结论：加强前列腺手术术前、术后的护理干预对前列腺术后膀胱痉挛的发生具有预防和辅助治疗作用。     

浸润性膀胱癌行膀胱全切除加原位回肠代膀胱术的围手术期护理

目的探讨膀胱全切除加原位回肠代膀胱术的围手术期护理以及指导术后代膀胱功能训练技巧。方法浸润性膀胱癌手术患者6例,年龄42～67岁,平均年龄56岁,均为男性。术前护理着重于心理护理和肠道准备;术中密切配合,严格无菌操作和无瘤技术;术后重点加强各引流管的护理,积极预防并发症,同时注重代膀胱功能的训练。结果6例手术患者于4～6周后均恢复控尿功能,无排尿困难及尿失禁。结论充分的术前准备,严密的术中配合,精心的术后护理以及恢复期代膀胱功能的训练,是确保手术成功的关键。     

The Drake Health Registry Study: findings from fifteen years of continuous bladder cancer screening

BACKGROUND: The Drake Health Registry Study (DHRS) is an ongoing bladder cancer screening program initiated in 1986 due to workers' probable past exposure to the bladder carcinogen, beta-naphthylamine (BNA). METHODS: At periodic screening visits, a health survey is administered and three screening tests are applied to a urine sample, urinalysis (UA), papanicolaou (PAP), and quantitative fluorescence image analysis (QFIA). Positive screens are eligible for a free bladder cystoscopy with random biopsies. RESULTS: Forty of 51 persons eligible for diagnostic evaluation underwent cystoscopy. One person was diagnosed with carcinoma in situ, two with transitional cell papilloma, 14 with dysplasia, two of which developed transitional cell carcinoma; 26 had bladder abnormalities such as chronic inflammation, chronic cystitis, atypical changes, atypia, hyperplasia, or papillary clusters. CONCLUSIONS: The DHRS continues to identify early stage bladder cancer and other abnormalities among workers exposed to BNA before 1981 and generates useful clinical, psycho-social, and epidemiologic data.     

Efficient scheduling of cystoscopies in monitoring for recurrent bladder cancer

Proper timing for repeated evaluations is difficult to assess. The authors analyzed scheduling of cystoscopy to monitor patients for detection of recurrent bladder cancer assuming that 1) minimizing tumor detection delay helps prevent cancer morbidities; 2) only limited numbers of cystoscopies are available; 3) prediction of recurrence or progression to invasive cancer is uncertain; 4) future tumors recur according to a Poisson process. Assumptions 3 and 4 permit estimation of each patient's recurrence rate. Thus, patients may be compared according to their relative risks of future tumors. With these assumptions, nonlinear optimization theory was used to calculate monitoring schedules for a model practice. Given 5.4 available visits per week per 100 patients, cystoscopy was recommended in 9-11 weeks for high-risk patients and in 30-40 weeks for low-risk patients, depending on stages, grades, and numbers of previous tumors. In contrast, standard cystoscopy was recommended in 13, 26, or 52 weeks, depending only on time elapsed since last recurrence. The calculated schedule implied an average detection delay for potentially invasive tumors of eight weeks, while standard practice led to detection delays of 11 weeks (38% worse). These results suggest that inclusion of each patient's tumor history in an optimization approach may improve follow-up care for patients who have superficial bladder cancers. This approach is being evaluated in a larger clinical setting.     

Sex and the Diagnostic Pathway to Bladder Cancer among Veterans: No Evidence of Disparity

BackgroundLonger time intervals from presentation with hematuria to bladder cancer diagnosis have been reported among women compared with men. Despite women being the fastest growing cohort within the Department of Veterans Affairs, little is known about women veterans with bladder cancer. Our objectives were to quantify the time from hematuria to bladder cancer diagnosis in Department of Veterans Affairs and assess differences between sexes.MethodsThis was a retrospective cohort study of patients diagnosed with bladder cancer from 2001 to 2016. Included were patients with hematuria for fewer than 365 days before a bladder cancer diagnosis and who had a record of diagnostic cystoscopy after hematuria but before diagnosis. We evaluated the number of days from hematuria to diagnostic cystoscopy (clinical appraisal), cystoscopy to bladder cancer diagnosis (surgical appraisal), and hematuria to bladder cancer diagnosis (total diagnostic appraisal). We used quantile regression models to separately evaluate the effect of sex on the three appraisal intervals.ResultsData from 213 women and 24,295 men were analyzed. The median clinical appraisal time was 78 days for women and 72 for men (p = .49). The median surgical appraisal time was 32 days for women and 33 for men (p = .74). The median total diagnostic appraisal time was 135 days for women and 130 for men (p = .71). Multivariable analyses showed no differences between men and women for any of the three appraisal intervals.ConclusionsThe majority of time from hematuria to bladder cancer diagnosis is spent in clinical appraisal, but little difference was observed between men and women in Department of Veterans Affairs.     

Bowel perforation during placement of a tension-free vaginal tape for stress urinary incontinence

A 46-year-old non-obese woman with no previous history of pelvic surgery underwent a tension-free vaginal tape (TVT) procedure for the treatment of stress urinary incontinence. Perioperative cystoscopy revealed that both trocars had perforated the bladder. The procedure was cancelled due to excessive bleeding in the bladder, which impaired visibility by cystoscopy. Postoperatively the patient had increasing abdominal pain, anaemia and a tendency to collapse. Laparotomy was performed and, in addition to a haematoma in the retropubic space, 2 perforations were detected in the small intestine; these perforations were closed. Bowel perforations during TVT procedures are rare but sometimes fatal. They have been described in the literature and appear to be under-reported. Patients typically develop symptoms immediately after surgery, but some exceptional cases may develop symptoms after a few months. Bowel perforation should be considered when unexplainable symptoms arise after a minimally invasive procedure like TVT. Because this rare complication can be life-threatening, early recognition is very important.     

CO2气膀胱膀胱镜应用于输尿管膀胱壁段结石手术

目的探讨CO2气膀胱膀胱镜输尿管膀胱壁段结石电勾切开取石手术的安全性及有效性。方法8例患者均为单侧输尿管膀胱壁段结石。建立气膀胱，压力8～10mmHg，下腹部建立1～2个5mm曲卡，以30。膀胱镜作观察镜行患侧输尿管膀胱壁段结石电切取石手术。结果手术均获成功，手术时间20～40mnin术中估计出血0-5ml，术后1周拔导尿管，住院3～5d，术后1个月膀胱镜下拔双“J”管，无尿瘘发生。随访3～6个月，症状消失，肾积水消失，膀胱造影无返流。结论气膀胱输尿管膀胱壁段结石电勾切开取石手术是治疗输尿管膀胱壁段结石安全有效的微创手术方式。     

CO_2气膀胱膀胱镜应用于输尿管膀胱壁段结石手术

目的探讨CO2气膀胱膀胱镜输尿管膀胱壁段结石电勾切开取石手术的安全性及有效性。方法8例患者均为单侧输尿管膀胱壁段结石。建立气膀胱,压力8～10mmHg,下腹部建立1～2个5mm曲卡,以30°膀胱镜作观察镜行患侧输尿管膀胱壁段结石电切取石手术。结果手术均获成功,手术时间20～40min,术中估计出血0～5ml,术后1周拔导尿管,住院3～5d,术后1个月膀胱镜下拔双"J"管,无尿瘘发生。随访3～6个月,症状消失,肾积水消失,膀胱造影无返流。结论气膀胱输尿管膀胱壁段结石电勾切开取石手术是治疗输尿管膀胱壁段结石安全有效的微创手术方式。     

羟基喜树碱和吡柔比星组合膀胱灌注预防表浅性膀胱癌术后复发

目的探讨羟基喜树碱(HCPT)和吡柔比星(THP)组合膀胱灌注预防表浅性膀胱癌术后复发的效果和安全性。方法应用HCPT、THP及HCPT+THP同时法和HCPT+THP序贯法组合行膀胱癌患者电切或部分切除后膀胱内灌注,随访2年,记录每次膀胱灌注后的局部及全身反应情况,3个月行1次膀胱镜复查。结果HCPT+THP序贯法膀胱灌注,2年后膀胱癌复发率7.5%,明显低于单用HCPT/THP和HCPT+THP同时法;而HCPT+THP序贯法膀胱灌注,其尿路刺激征、血尿及肝肾功能等毒副作用与单用HCPT和TH无显著性差别。结论HCPT+THP序贯法膀胱灌注预防表浅性膀胱癌术后复发效果好,较单用HCPT/THP和HCPT+THP同时法其复发率低,而毒副作用无显著性差异,因此是一种更有效的灌注方法。     

Evaluation of nonlinear optimization for scheduling of follow-up cystoscopies to detect recurrent bladder cancer. The Bladder Cancer follow-up Group.

Standard recommendations for patients who have had superficial bladder cancer are inspection by cystoscopy quarterly for a year or two after tumor removal, then half-yearly and yearly. The authors assessed the potential for improvement in scheduling cystoscopies according to probabilistic optimization techniques. Eight hypothetical practices were created, based on retrospective analysis of 918 bladder-cancer-patient charts. Standard and alternative recommendations for the interval to next cystoscopy were compared. The alternatives were derived from patient-specific predictions of future tumor risks (based on the patient's prior recurrence rate and tumor stage and grade) and a nonlinear optimization approach to allocation of the same number of cystoscopies as were available for standard follow-up. The optimization proposed longer intervals between visits for low-risk patients and shorter intervals for high-risk patients. Overall, optimization reduced expected tumor detection delays by 30%, from 12.6 to 8.7 weeks. When optimization intervals were shorter than standard, cancer was found more often at subsequent cystoscopies (34% vs 27%, p less than 0.05), suggesting that the optimization was a better predictor of cancer recurrence. If reduction in tumor-detection delay is the goal of follow-up for recurrent cancers, then urologists can improve monitoring by using probabilistic optimization methods for scheduling cystoscopies. Further understanding of the accuracy of predictive models for bladder-cancer recurrence rates is desirable. Subsequently, the optimization method developed here may be tested prospectively.     

CT膀胱仿真内窥镜的临床应用

目的 总结CT膀胱仿真内窥镜(CTVC)的临床应用,探讨其临床应用的意义.方法 对具有临床指征的13例患者,在膀胱排空后静脉推注造影剂,待膀胱充盈后行膀胱区域的薄层螺旋CT扫描,采集数据进行后期处理.应用三维导航软件建立CTVC图像.全部病例均有膀胱镜对照检查资料,并将检查结果结合手术、病理结果作对照分析.结果 13例患者中诊断为膀胱肿瘤9例,良性前列腺增生3例(合并膀胱憩室1例),腺性膀胱炎1例,CTVC检查漏诊腺性膀胱炎1例,其余疾病均获得正确诊断.CTVC总诊断符合率92.3%,膀胱肿瘤临床诊断符合率100.0%.结论 CTVC在显示膀胱腔内病变方面具有较好的敏感性,作为非侵入性诊断方法,具有较好的临床应用价值.