下尿路内翻性乳头状瘤56例报告

目的 提高下尿路内翻性乳头状瘤临床诊治水平.方法 回顾性分析1995年8月至2006年7月,我院收治的下尿路内翻性乳头状瘤56例,其中男44例、女12例,平均年龄55.3岁.临床表现主要为无痛性肉眼血尿和排尿困难.诊断依据B超、内镜检查及病理检查.肿瘤位于膀胱53例,行经尿道膀胱肿瘤电切术(TURBT)41例,经尿道膀胱肿瘤激光切除术3例,膀胱部分切除术8例,全膀胱切除术1例.肿瘤位于尿道3例,行前列腺部尿道肿瘤电切术2例,尿道外口肿瘤切除术1例.14例特殊病理类型的肿瘤术后予规范的膀胱灌注化疗和随访.结果 病理诊断:膀胱内翻性乳头状瘤41例,非典型性膀胱内翻性乳头状瘤4例,混合性肿瘤(膀胱内翻性乳头状瘤 移行细胞癌)8例;尿道内翻性乳头状瘤3例.45例随访1个月-11年,平均5.5年,3例特殊病理类型的肿瘤术后复发膀胱移行细胞癌,均行TURBT.结论 下尿路内翻性乳头状瘤容易误诊,需术后病理检查确诊;TUR是标准治疗方法;大部分为良性肿瘤,预后良好,但特殊病理类型的膀胱内翻性乳头状瘤术后需按移行细胞癌处理,进行规范的膀胱灌注化疗和随访.

Inverted papilloma of the low urinary tract: report of 56 cases

Objective To improve the diagnosis and treatment of inverted papilloma in the low urinary tract. Methods Data of 56 cases were analysed retrospectively. ALL cases consisted of 44 males and 12 females. Patient age ranged from 29 to 81 years(mean 55.3). Most patients complained of painless gross hematuria and dysuria. The diagnosis was established mainly by ultrasonography, endoscopy and pathological examination. Of the 53 cases with inverted papilloma in the bladder transurethral bladder tumor resection was performed in 41 cases, transurethral laser resection in 3, partial cystectomy in 8, total cystectomy in 1. Of the 3 cases with inverted papilloma in the urethra transurethral prostatic urethral tumor resection was performed in 2 case, urethral orifice tumor resection in 1 case. 14 cases with special pathological types of inverted papilloma in the bladder underwent regular intravesical instillation with chemotherapeutic drug and followup. Results Of the cases with tumor in the bladder postoperative pathological diagnosis was inverted papilloma in 41 cases, atipical inverted papilloma in 4, mixed tumor (inverted papilloma and transitional cell carcinoma) in 8. The postoperative pathological diagnosis of other 3 cases was inverted papilloma in the urethra. 45 of 56 cases were followed. Follow up ranged from 1 month to 11 years (mean 5.5 years). Recurrence was found in 3 cases. All were treated by TURBt. Conclusions The confirmation of diagnosis of inverted papilloma in the low urinary tract relies on postoperative pathological examination. Transurethral resection is the standard theraputic choice. It is mostly a benign tumor and has good prognosis .But the treatment of special pathological types of inverted papilloma in the bladder is the same as that of TCC,which includes regular intravesical instillation and followup oberservation after initial resection.