膀胱内翻性乳头状瘤的诊断与治疗（附12例报告）

目的提高膀胱内翻性乳头状瘤（inverted papilloma of the bladder,IPB）的诊治水平。方法回顾性分析我院12例膀胱内翻性乳头状瘤患者的临床资料,结合文献资料进行探讨。结果 12例患者接受经尿道膀胱肿瘤电切术（TURBt）治疗,患者术后均恢复良好,无严重并发症。4例伴有前列腺增生者,同时行TURP术,术后排尿良好。术后病理明确诊断为膀胱内翻性乳头状瘤,其中小梁型9例、腺体型3例。4例同时行TURP者,术后前列腺组织病理为良性前列腺增生。术后均给予膀胱灌注化疗。术后随访6月-8年,未见肿瘤复发及恶性变。结论 IPB多见于男性,膀胱颈部和三角区多发,呈良性肿瘤特点生长,预后良好。诊断依赖于膀胱镜检查及术后病理检查。TURBt是IPB的标准治疗方法 ,术后给予膀胱灌注化疗有利于预防复发。     

膀胱内翻性乳头状瘤的临床分析(附46例报告并文献复习)

目的:探讨膀胱内翻性乳头状瘤的临床特点,提高对其诊断要点、治疗及预后的认识。方法:回顾性分析46例膀胱内翻性乳头状瘤的临床资料,复习相关文献,并随访患者。结果:46例患者均经手术治疗;术后病理证实均为膀胱内翻性乳头状瘤,其中1例合并膀胱移行细胞癌,2例合并局灶性恶变;术后均行膀胱灌注治疗,术后生存良好,随访3个月-5年,肿瘤复发者1例,其余均无瘤生存至今。结论:膀胱内翻性乳头状瘤是泌尿系少见的良性肿瘤,易合并移行细胞癌,很少复发,预后良好;确诊主要依靠膀胱镜及病理活检;TURBt术是其标准治疗方法;术后应膀胱灌注并定期复查膀胱镜,以防治尿路上皮癌的发生。     

膀胱偶发肿瘤的的诊断与治疗

背景与目的：膀胱偶发肿瘤的国内外报道较少，有必要总结一下膀胱偶发肿瘤的临床特点，以提高膀胱偶发肿瘤的诊治水平。方法：回顾性分析11例膀胱偶发肿瘤的临床资料。常规体检B超发现6例，膀胱镜下置放或拔双J管发现3例，经尿道前列腺电切（TURP）术中发现2例，肿瘤直径0．2～1．5cm。结果：11例均行经尿道膀胱肿瘤电切（TURBT）术，术后病理：乳头状瘤1例，内翻性乳头状瘤2例，乳头状低度恶性倾向的尿路上皮肿瘤3例，低级别的乳头状尿路上皮癌5例。所有膀胱癌患者TURBT术后接受即刻单剂膀胱灌注化疗，术后定期膀胱镜复查。随访半年至10年，复发1例。结论：膀胱偶发肿瘤中膀胱癌多见，但恶性程度低，肿瘤表浅,预后良好，术后复发率低。     

同期经尿道电切术治疗膀胱癌合并良性前列腺增生的临床分析

目的探讨同期经尿道切除膀胱肿瘤和前列腺治疗表浅性膀胱癌合并良性前列腺增生症的手术安全性和临床疗效。方法 72例表浅性膀胱癌合并良性前列腺增生症患者,先行经尿道膀胱肿瘤电切术(TURBT)切除肿瘤后同期行经尿道前列腺电切术(TURP)切除前列腺。结果患者均顺利完成手术,无膀胱穿孔和电切综合征发生,术后随访14～54个月,平均24个月,35例发生膀胱肿瘤复发,平均复发时间16个月,复发部位均不在膀胱颈口和前列腺尿道,全部再次行TURBT。结论同期经尿道切除膀胱肿瘤和前列腺治疗表浅性膀胱癌合并良性前列腺增生症手术安全、短期疗效确切,可适用于一部分年龄较大伴有严重的下尿路梗阻的且肿瘤分期、分级低的表浅性膀胱肿瘤患者。     

经尿道电切术联合丝裂霉素灌注治疗非浸润性膀胱尿路上皮癌70例报告

目的:探讨经尿道膀胱肿瘤电切术(TURBT)联合丝裂霉素膀胱灌注治疗非浸润性膀胱尿路上皮癌的临床疗效及并发症和不良反应.方法:采用TURBT联合丝裂霉素膀胱灌注治疗70例非浸润性膀胱尿路上皮癌患者,回顾性分析患者的临床病理资料.结果:一次性切除68例,分期切除2例,手术时间30分钟～60分钟,平均住院10天,无手术并发症发生.术后病理诊断移行细胞癌64例,乳头状癌6例,术后随访3个月～2年,8例复发,复发率为11.4％(8/70).结论:TURBT联合丝裂霉素膀胱灌注治疗非浸润性膀胱尿路上皮癌效果良好,并发症少.     

膀胱内翻性乳头状瘤的诊断和治疗(附33例报告)

目的 提高对膀胱内翻性乳头瘤（IPB）的诊断和治疗水平。方法 回顾性分析33例IPB的临床资料,29例采用经尿道膀胱肿瘤电切术（TURBT）,4例行膀胱部分切除术,术后膀胱灌注化疗预防复发。结果 病人术后生存良好,30例获得随访3mo～2a,未见肿瘤复发或恶变。结论 IPB是一种少见的尿路上皮肿瘤,预后良好。诊断依赖于膀胱镜检及术后病理检查,TURBT是本病主要的治疗方法,术后予膀胱灌注化疗有利于预防复发。     

浅表性膀胱癌经尿道行肿瘤电切术临床探讨

目的:探讨浅表性膀胱癌经尿道行膀胱肿瘤电切术(TURBt)治疗的临床疗效。方法:对26例浅表膀胱肿瘤患者行经尿道电切术,其中8例伴有前列腺增生症,6例同期行经尿道前列腺电切术(TURP)。观察其疗效及并发症。结果:26例患者成功实施(TURBT)术,术后随访3个月～4年,平均2年;输尿管开口损伤1例。无严重出血等并发症。有7例肿瘤复发,1例死于肿瘤远处转移。结论:TURBT治疗浅表膀胱肿瘤是一种安全有效的方法,具有操作简单、损伤小、恢复快、并发症少等优点。     

膀胱内翻性乳头状瘤的临床特征及治疗

我院从１９８１年初至１９９８年４月间，共收治膀胱内翻性乳头状瘤１０例，占膀胱肿瘤总数的１．３％（１０／７７１）。临床资料　本组１０例均为男性，年龄２８～６８岁，平均５２岁。病程２～９０个月，平均２５个月。尿脱落细胞检查均未见癌细胞。９例经腹Ｂ超及膀胱镜检查诊断为膀胱肿瘤；１例前列腺增生症患者，术前Ｂ超、ＣＴ检查均未发现膀胱肿瘤，术中见膀胱颈部尿道内口稍前侧有一０．１ｃｍ×０．１ｃｍ×０．５ｃｍ小乳头状肿瘤。结果　本组１０例均采用手术治疗，病理诊断为膀胱内翻性乳头状瘤。术后均未做膀胱内灌注治疗。所…     

浅表性膀胱癌经尿道行肿瘤电切术临床探讨

目的：探讨浅表性膀胱癌经尿道行膀胱肿瘤电切术（TURBt）治疗的临床疗效。方法：对26例浅表膀胱肿瘤患者行经尿道电切术，其中8例伴有前列腺增生症，6例同期行经尿道前列腺电切术（TURP）。观察其疗效及并发症。结果：26例患者成功实施（TURBT）术，术后随访3个月～4年，平均2年；输尿管开口损伤1例。无严重出血等并发症。有7例肿瘤复发，1例死于肿瘤远处转移。结论：TURBT治疗浅表膀胱肿瘤是一种安全有效的方法，具有操作简单、损伤小、恢复快、并发症少等优点。     

膀胱内翻性乳头状瘤的影像学特征及治疗对策

目的 探讨膀胱内翻性乳头状瘤的影像学特征及治疗对策.方法 回顾性分析6例膀胱内翻性乳头状瘤患者的临床资料,结合文献对膀胱内翻性乳头状瘤的临床特点进行分析.结果 6例患者术前均行B型超声检查,肿瘤声像图表现为肿块边缘呈锯齿状强回声,内部呈不均质或均质的低回声,肿瘤形状不规则,局限于黏膜与黏膜下层,膀胱壁肌层完整.4例术前行CT检查发现膀胱内不规则软组织肿物,未见明显穿过肌层影像表现,提示膀胱肿瘤.3例行静脉肾盂造影,显示膀胱区域充盈缺损.所有患者均行膀胱镜检查,镜下表现为实性肿块突入腔内,肿块表面被覆正常膀胱黏膜,血管走形稀疏.所有患者均接受经尿道膀胱肿瘤电切术,术后随访无复发.结论 膀胱内翻性乳头状瘤呈良性肿瘤特点,超声检查可作为筛查手段,确诊依赖于膀胱镜联合活组织病理检查,经尿道膀胱肿瘤电切术是膀胱内翻性乳头状瘤的标准治疗方法.     

Natural history of urothelial inverted papilloma

BACKGROUND: Inverted urothelial papilloma is an uncommon urothelial neoplasm. Although it is traditionally regarded as a benign tumor, conflicting data on multiplicity, recurrence rate, and association with urothelial carcinoma have left uncertainties concerning its biologic behavior. METHODS: The authors analyzed the clinicopathological characteristics of 75 cases of inverted papilloma in the urinary tract without prior or concurrent urothelial carcinoma to determine its biologic behavior and prognosis, and to correlate these findings with surveillance strategies. RESULTS: These patients ranged in age from 26 to 85 years (mean, 60 years). Of the 46 patients for whom tobacco use history was available, 28 gave a history of smoking. Inverted papillomas were located in the urinary bladder (67 cases), prostatic urethra (4 cases), and ureter (4 cases). The majority of vesical tumors arose from the trigone or near the bladder neck. Common presenting complaints included hematuria, dysuria, and irritative voiding symptoms. In 1 case of vesical inverted papilloma, there was a recurrence. All other patients were free of tumor recurrence or progression during a mean follow-up of 68 months (range, 2-240 months). CONCLUSIONS: Both the extremely low incidence of tumor recurrence (1%) and strikingly favorable prognosis suggest that inverted urothelial papilloma, when diagnosed according to strictly defined criteria, is a benign urothelial neoplasm not related to urothelial carcinoma. Therefore, complete transurethral resection of inverted papilloma is adequate surgical therapy, and surveillance protocols as rigorous as those employed in the management of urothelial carcinoma seem unnecessary.     

膀胱肿瘤合并前列腺增生症行同期手术治疗的临床分析

目的:分析膀胱肿瘤合并前列腺增生症行同期手术治疗的临床效果.方法:随机选取延安大学附属医院收治的2011年1月到2015年1月50例符合临床同期手术指征的同期膀胱肿瘤合并前列腺增生症患者,依据随机分配方法,分为研究组（25例）、对照组（25例）.对照组患者应用TURP（经尿道前列腺电切术）、TURBT（经尿道膀胱肿瘤电切术）分期手术治疗.研究组患者采取TURP+TURBT同期手术治疗,对比两组患者临床手术疗效.结果:研究组患者治疗之后明显改善临床指征,临床疗效好,在缩小肿瘤体积、改善患者尿动力方面,明显优于对照组,两组对比差异有统计学意义（P<0.05）.结论:膀胱肿瘤合并前列腺增生症符合同期手术指征的患者,行TURP+TURBT效果优于TURP、TRBT分期手术.不仅提升临床手术疗效,优良率高,还可降低术后并发症.     

经尿道膀胱肿瘤电切术(TURBT)治疗浸润性膀胱癌

目的:探讨经尿道膀胱肿瘤电切术(TURBT)治疗浸润性膀胱癌的治疗效果。方法:分析27例采用TURBT治疗浸润性膀胱癌患者的临床随访资料,随访时间3~86个月,平均26.4个月。手术参照根治性TURBT手术原则,切除深度均达肌层或膀胱壁外脂肪层。结果:复发12例,总复发率44.4%(12/27)。死亡11例,死亡率41%(11/27)(其中3例死亡原因非膀胱肿瘤所致)。肿瘤复发后再次行`TURBT者22例次,最多的病例达8次。结论:对于年老体弱不能耐受或不愿意接受膀胱全切的浸润性膀胱癌患者可施行TURBT,以达到延长生命,提高生活质量的目的。     

Prognostic value of p53, p21/WAF1, Bcl-2, Bax, Bak and Ki-67 immunoreactivity in pT1 G3 urothelial bladder carcinomas.

pT1 G3 bladder carcinomas are heterogeneous with respect to tumor recurrence and progression. Whereas some urologists treat these carcinomas by repeated transurethral resections often followed by intravesical chemotherapy or BCG instillation, others recommend cystectomy after tumor recurrence or early cystectomy after the initial diagnosis. Our goal was to determine the prognostic value of p53, p21/WAF1, Bcl-2, Bax, Bak, and Ki-67 immunoreactivity in these tumors. There were 30 patients with a new histopathological diagnosis of pT1 G3 urothelial carcinoma based on a transurethral resection specimen. Representative sections of these specimens were examined for the above markers. All patients were followed up regularly and were classified as being tumor free or having tumor recurrence or progression. The mean follow-up period was 43 months (range: 8-102 months). Twenty-five patients underwent radical cystectomy and 7 of these (28%) suffered from tumor progression and died of bladder cancer. In 5 patients, surgery was limited to a transurethral resection and 4 of these patients developed superficial tumor recurrence. There was a significant difference in tumor-free survival between patients with p53-immunoreactive (mean: 30 months) and p53-negative tumors (mean: 82 months; p = 0.0341). Bcl-2 positivity was also associated with decreased tumor-free survival (p = 0.043). The other markers had no significant prognostic impact. We conclude that p53 and Bcl-2 immunoreactivity labels the most aggressive pT1 G3 bladder carcinomas.     

Two cases of plasmacytoid variant of urothelial carcinoma of urinary bladder: systemic chemotherapy might be of benefit

We report two cases of the plasmacytoid variant of urothelial carcinoma of urinary bladder in which systemic chemotherapy was effective. In the first case, a 76-year-old man presented with dysphasia. Magnetic resonance imaging (MRI) and computed tomography revealed a brain tumor and a bladder tumor. Resection of the brain tumor and transurethral resection of the bladder tumor were performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder with brain metastasis (pT1N0M1). Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) chemotherapy were performed. He has no evidence of recurrence 96 months after resection of brain metastasis. In the second case, a 76-year-old man presented with hematuria. MRI revealed a bladder tumor with abdominal wall invasion, and a transurethral biopsy was performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder (cT4bN0M0). After three cycles of neoadjuvant GC (gemcitabine and cisplatin) chemotherapy, MRI demonstrated a complete response. Radical cystectomy was performed, and the pathological diagnosis was pT0pN0. Although there was no evidence of recurrence 9 months after radical cystectomy, he died from other causes. Our two cases suggest that systemic chemotherapy might be effective for the plasmacytoid variant of urothelial carcinoma.     

经尿道切除膀胱多发肿瘤和巨大肿瘤

目的:探讨经尿道切除膀胱多发肿瘤和巨大肿瘤的治疗效果。方法:采用经尿道膀胱肿瘤切除（TUR-BT）手术治疗29例膀胱多发肿瘤和/或巨大肿瘤,术后常规膀胱灌注,5例接受系统性化疗。每3个月行膀胱镜检查,必要时再次行TUR-BT手术或全膀胱切除术。结果:术后病理结果均为膀胱癌。随访3-72月,18例存活5年以上。在所有病例中,4例术后1年内死于肿瘤转移,8例无瘤生存,17例术后1-3年复发。复发病例中14例再次或多次行TUR-BT手术,2例行全膀胱切除术,1例行单纯尿流改道手术。结论:经尿道切除膀胱多发肿瘤和巨大肿瘤可以获得较好的治疗效果,根治性TUR-BT辅以系统性化疗或许是膀胱多发肿瘤和/或巨大肿瘤而又希望保留膀胱的病人的理性选择。