膀胱非上皮性肿瘤的诊断与治疗（附11例临床分析）

目的：总结膀胱非上皮性肿瘤的诊治特点,探讨治疗方法与预后的关系。方法：回顾性分析11例膀胱非上皮肿瘤临床资料。男7例。女4例。年龄32—65岁。其中血尿6例,尿频2例,排尿困难1例,排尿晕厥2例。超声及CT检查发现11例膀胱占位病变,均行膀胱镜检查及活检。结果：9例良性肿瘤行单纯肿瘤剜除术或膀胱部分切除术;2例恶性肿瘤均行膀胱全切术。恶性肿瘤术后辅助化疗、放疗。随访3个月-3年。良性肿瘤均无复发,恶性肿瘤2例死于术后3年内,平均存活13个月。结论：膀胱非上皮性肿瘤临床上少见,病理类型复杂,恶性居多,预后较差。误诊率高,深部活检可提高其诊断率。膀胱部分切除术或膀胱全切术是本病的主要治疗方法．良性肿瘤应完整切除．恶性肿瘤应争取广泛切除．结合其病理特点辅助放化疗可提高疗效。     

鼻腔鼻窦少见非上皮性良性肿瘤16例分析

鼻腔鼻窦解剖结构位置比较隐蔽,早期肿瘤临床表现常无特异性。随着CT、MRI等影像技术和鼻内镜技术的发展,使早期发现肿瘤并进行根治性手术成为可能。2003年6月-2006年3月,我们共收治鼻腔鼻窦少见非上皮性肿瘤16例,疗效满意。现分析报告如下。     

卵巢非上皮性肿瘤的影像诊断与病理对照研究

目的 分析卵巢非上皮性肿瘤的影像表现与病理结果,提高对卵巢非上皮性肿瘤的影像诊断与鉴别诊断.方法 收集经手术病理证实的卵巢非上皮肿瘤患者34例,分析其影像特征,并与病理对照.结果 畸胎瘤13例,卵巢颗粒细胞瘤6例,卵巢纤维瘤6例,卵泡膜细胞瘤5例,无性细胞瘤2例,卵巢内胚窦瘤2例;各种卵巢非上皮性肿瘤各有其影像及临床特征.结论 卵巢非上皮性肿瘤CT及MR表现有一定的特征性,结合发病年龄、临床症状及生化检查,可作出定性诊断.     

非上皮性膀胱肿瘤影像表现（附10例分析）

目的探讨非上皮性膀胱肿瘤的诊断.材料和方法对近8年10例经手术病理证实的非上皮性膀胱肿瘤的影像表现及临床资料进行回顾性分析.结果除横纹肌肉瘤增强明显状如葡萄、平滑肌瘤边缘清晰光滑、副神经节瘤可多发有参考作用外,大多数非上皮性膀胱肿瘤影像无特殊征象.结论多数非上皮性膀胱肿瘤单就影像表现诊断困难,需结合临床资料;有些病例术前无法诊断,要依靠膀胱镜活检病理确诊.     

膀胱嗜铬细胞瘤一例

患者　女,５４岁。体检行Ｂ超检查时发现“膀胱左后壁实性占位性病变”而入院。无明显尿频、尿急、尿痛及肉眼血尿,既往无高血压病史,无头昏、头痛病史。体检及实验室检查无特殊。超声检查：膀胱左后壁可见一约０．８ｃｍ×０．９ｃｍ×１．１ｃｍ大小的突向腔内的中等强回声结节（图１）,膀胱壁连续性好,未见破坏。超声诊断：膀胱占位,膀胱癌待排。ＣＴ检查：膀胱左后壁偏下可见一约０．９ｃｍ×０．９ｃｍ大小的突向腔内的结节影,边缘光整,ＣＴ值为３７．２ＨＵ（图２）。增强后,结节明显均一强化,ＣＴ值为６１．４ＨＵ（图３）…     

膀胱异位嗜铬细胞瘤一例

病例资料　患者 ,女 ,5 6岁。排尿时头痛、心悸 10年 ,严重时晕倒 ,但无尿急、尿频、尿痛及排尿困难 ,无血尿、发热等症状。曾在本院及外地医院就诊 ,按更年期综合征治疗 ,症状无改善。查体 :间隙期血压 18/ 12kPa ,排尿后血压达 2 4/14kPa ,体温 3 6.4℃ ,脉搏 72次 /分 ,呼吸     

膀胱异位嗜铬细胞瘤1例

1病例报告 患者女,39岁。因无痛性血尿7个月就诊。患者7个月前无明显诱因出现无痛性血尿,为全程鲜红色肉眼血尿,夹有血块。予以抗炎及对症治疗后血尿仍间断出现。既往无高血压和排尿性晕厥史。     

膀胱嗜铬细胞瘤一例

嗜铬细胞瘤75%～90%发生于肾上腺髓质,可见于肾上腺以外的交感神经节或其他嗜铬组织.我     

膀胱肿瘤术前诊断方法的评价

膀胱肿瘤是泌尿系中最常见的肿瘤,发病年龄大多数为50～70岁,男性发病率显著高于女性,男女之比约为4：1。根据组织类型,膀胱肿瘤分为上皮性和非上皮性肿瘤两类,95％以上为上皮性肿瘤,非上皮性肿瘤极少见。根据分化程度,膀胱肿瘤可分为乳头状瘤、乳头状低度恶性倾向的尿路上皮肿瘤、     

膀胱壁嗜铬细胞瘤1例

到嗜铬细胞瘤中的10%发生在肾上腺以外,称为异位嗜铬细胞瘤。本文报告影像学诊断后施行手术治疗,并经病理证实的膀胱壁嗜铬细胞瘤1例如下。患者女,54岁。因排尿时头痛、头晕10 年,以膀胱嗜铬细胞瘤收入院.查体:T37℃,P 82次/min,R21次/min,BP14/8kPa。中年女性,一般情况可。心肺(-)。左侧上肢前内侧皮下有一约1.5cm×2.5cm大小的包块,可活动,质韧。左侧下肢有一约10cm长的手术疤痕。余(-)。排尿试验:基础血压13/8kPa,憋尿至张力较高时出现上述症状,血压高达28/16kPa,平卧5min后血压降至19/11kPa。影像学检查:B超显示左侧膀胱壁有2cm×2c…     

磁共振扩散加权成像在膀胱癌术后随访中的应用价值

目的探讨扩散加权成像(DWI)及表观扩散系数(ADC)值在膀胱癌术后随访中的应用价值。资料与方法膀胱癌术后可疑复发患者44例,于3.0 TMRI上行常规平扫增强及DWI检查。比较增强序列与DWI鉴别膀胱癌复发及炎症的能力。采用配对t检验比较膀胱癌复发与炎症的ADC值区别,并绘制ADC值诊断膀胱癌复发的受试者工作特征(ROC)曲线。结果增强序列诊断膀胱癌复发的准确性、敏感性及特异性分别为79.5%、96%、57.9%;DWI为95.5%、96%、94.7%。DWI诊断结果与病理一致性相当好(Kappa=0.907),增强序列一致性中等(Kappa=0.564)。DWI与病理诊断结果的McNemar检验无显著差异(P>0.05),增强序列与病理诊断结果有显著差异(P<0.05)。膀胱癌复发的平均ADC值为(0.90±0.23)×10-3mm2/s,显著低于炎症(1.32±0.14)×10-3mm2/s。ADC值鉴别膀胱癌复发与炎症的准确率高(ROC曲线下面积=0.93),ADC值取1.075×10-3mm2/s时是最佳诊断界值(敏感性+特异性=1.833)。结论 DWI序列对膀胱癌术后鉴别肿瘤复发及炎症瘢痕有重要...     

放射性^99mTc标记血卟啉衍生物在膀胱肿瘤诊断中的应用

利用放射性~(99m)Tc标记HpD,在对带有膀胱肿瘤的裸鼠进行肿瘤组织和正常组织内HpD的分布水平和相对放射性强度研究的基础上,对50例膀胱肿瘤及14例非肿瘤患者作静注~(99m)Tc-HpD后的放射显像,另对10例膀胱肿瘤患者行静注游离~(99m)TeO_4-的放射显像对照。结果表明:50例肿瘤患者中,41例表现为异常(82％);14例非肿瘤患者中,12例表现正常(86％),有显著性差异(P<0.05)。10例~(99m)TcO_4-受检肿瘤患者中表现出与~(99m)Tc-HpD不同的放射性分布类型,与~(99m)Tc-HpD组相比,有非常显著性差异(P<0.001)。     

The accuracy of MDCT for staging of Wilms’ tumor

Aim of work

To evaluate the accuracy of multidetector computed tomography (MDCT) in staging of Wilms’ tumor.

Patients and methods

This prospective study was performed on 32 children (age range 4–8 years), having renal mass lesion, were studied with multidetector computed tomography (MDCT). Axial and multiplanar imaging were evaluated. All tumors were staged according to NWTS-4 classification. MDCT diagnosis was compared with surgical and pathohistological data.

Results

All the cases were staged according to the fourth trial of the National Wilms’ tumor Studies (NWTS-4). The 32 cases were found to have 36 tumors (4 cases were bilateral masses), 4 tumors were diagnosed as stage I, 9 tumors were diagnosed as stage II, 7 tumors as stage III, 8 tumors stage IV and 8 tumors were stage V.

Conclusion

In conclusion, MDCT represents a reliable diagnostic method for evaluating Wilms’ tumor and it is accurate and sensitive in diagnosing stages I, IV and V, but is not as accurate in the diagnosis of stages II and III and has poor correlation with histopathological data.     

泌尿系统疾病MDCT检查进展

MDCT的发展给泌尿系统疾病的检查方法和影像诊断带来很大变化和提高.本文旨在介绍MDCTA,薄层动态增强和多平面重建,MDCT灌注成像,MDCT尿路造影等的检查方法与技术及其在泌尿系统疾病诊断中的应用和意义.     

Role of the MDCT urography in diagnosis of renovascular diseases

Purpose

The current study aimed to evaluate the efficiency of the MDCT urography in the diagnosis of renovascular diseases.

Material and methods

Ten consecutive patients were recruited from the Urology out patients’ clinics of Assuit University. Their ages ranged from 22 to 60 years. Prior to Multidetector Computed Tomography (MDCT) examination, relevant clinical data and renal function tests were obtained in every patient.

Result

In the current study MDCT easily diagnosed during the arterial phase, six patients with renal aneurysms, two patients with nutcracker syndrome, one patient with arteriovenous malformation (AVM) and one patient of renal artery stenosis.

Conclusion

MDCT plays an important role in the evaluation and management of both primary renovascular disease and the secondary manifestations of each disease. MDCT angiography with multiplanar reconstruction and three-dimensional display is valuable in studying patients with renovascular lesions involving the proximal renal vessels.     

MDCT assessment of recurrent cholesteatoma

Recurrent cholesteatoma (RC) by CT showed an expansile lobulated soft tissue lesion with associated bone erosions, but it may be difficult to diagnose with certainty, especially when it is surrounded by inflammatory disease. The aim of the work was to study the MDCT features of RC. Subjects: The study included 30 patients (34 ears) with known history of previously managed cholesteatoma within the last five years and currently suffering from recurrent manifestations. Results: More than a half of the operative cavities proved to harbor RC that either verified during revision operation and/or DWI. Granulation tissue was found in 35.29% of the surgical cavities. Both RC and granulation tissue are represented as intermediate MDCT densities occupying the surgical cavity either partially or totally causing opacification of the recesses. MDCT was not able to differentiate between the densities of RC and granulation tissue. However the extent of opacification into the different middle ear cavity recesses as well as the ossicular and bony elements could be excellently assessed. Conclusions: Bony erosions in post mastoidectomy status, representing the clinical interest prior to revision surgery may be attributed to the previous cholesteatoma or surgery and not necessarily due to more aggressive behavior of RC.     

Scimitar syndrome: MDCT imaging revisited

Scimitar syndrome refers to a form of anomalous pulmonary venous drainage which implies partial or total failure of the pulmonary veins to reach the left atrium.AimTo emphasize the role of MDCT in the diagnosis of Scimitar syndrome.Patients and methodsWe presented MDCT imaging findings in three patients with Scimitar syndrome.ResultsMDCT revealed anomalous arterial blood supply from abdominal aorta to right lower lung lobe and anomalous venous drainage into infradiaphragmatic IVC, hypoplastic right pulmonary artery and hypoplastic right lung as well as atrial septal defect and bronchial diverticulum.ConclusionMDCT is essential investigation in Scimitar syndrome.     

多层螺旋CT仿真内镜技术在膀胱癌诊断中的价值

目的探讨多层螺旋CT仿真内镜(CTVE)成像技术及其在膀胱癌诊断中的价值。资料与方法对血尿，B超发现膀胱内占位者28例行多层螺旋CT仿真膀胱内镜(MSCTVE)和常规膀胱内镜检查。其中23例采用导人法，通过导尿管将4．8％泛影葡胺300～500ml注入膀胱，行膀胱及后尿道扫描；5例采用排泄法．经肘静脉注射非离子型对比剂90ml，延迟30min行全尿路扫描；将膀胱原始资料传至工作站，采用Voyager软件行CTVE影像重建，对膀胱癌进行评价。结果常规膀胱镜证实的38枚膀胱肿瘤MSCTVE显示35枚，准确率92．1％，其中膀胱移行细胞癌25例，鳞状上皮细胞癌、壁内段输尿管癌、膀胱癌术后复发各1例，输尿管口和尿道内口显示率分别为75％和100％。结论MSCTVE具有图像清晰逼真、大视野、无盲区等特点，能较准确地反映膀胱内占位性病变，是常规膀胱镜及外科手术的有益补充，也可作为尿道狭窄、严重血尿或患者拒绝传统膀胱镜等条件下替代常规膀胱镜的检查方法之一。     

多排螺旋CT在胃肠道间质瘤的临床应用

目的:探讨胃肠道间质瘤(GIST)的多排螺旋CT(MDCT)表现与其生物学危险性的相关性.方法:回顾性分析43例经病理证实的GIST患者的MDCT表现(包括CIST的大小、坏死与否、牛长方式、形态及强化程度),并与其生物学危险性分级进行对照.结果:本组43病例中,病理证实胃GIST21例,小肠GIST11例,肠系膜GIST6例,十二指肠GIST2例,网膜GIST1例.结肠GIST2例.高度危险性17例,中度危险性10例,低度危险件11例,极低危险性5例.CT发现43例,40个定位正确,分别是胃21例、小肠10例、肠系膜5例、十二指肠2例、结肠2例,3例定位错误,分别为1例肠系膜误判为来源十小肠、1例网膜误判为米源于肠系膜、1例小肠误判为来源丁肠系膜.CT影像表现与病理对照分析,GIST的大小、坏死与否、生长方式及形态与GIST的生物学危险性具有统计学意义,GIST的强化程度与GIST的生物学危险性小具有统计学意义.结论:胃肠道间质瘤多排螺旋CT影像表现具有一定的特征性,术前评估GIST的生物学危险性具有一定的价值.     

钬激光治疗多发性表浅膀胱肿瘤

目的 探讨钬激光治疗多发性表浅膀胱肿瘤的临床效果.方法 对43例多发性表浅膀胱肿瘤进行钬激光治疗,激光能量1.0～1.4 J,功率10～14 W,频率10 Hz.术后配合化疗药物或卡介苗灌注,观察其疗效.结果 41例应用钬激光将肿瘤顺利切除,2例改行开放手术.操作时间20～160 min,平均55 min.术后对38例进行了随访,随访时间6～24个月,3例复发.结论 钬激光治疗多发性表浅膀胱肿瘤操作较简单、对病人损伤小、疗效可靠.