腺性膀胱炎伴肾积水并发症的治疗分析

目的:探讨腺性膀胱炎伴单、双侧肾积水并发症的治疗方法和效果。方法:回顾性分析32例腺性膀胱炎患者的临床资料。将患者分为两组:单侧肾积水组21例,双侧肾积水组11例,均进行积极的局部治疗,包括经尿道电切和激光切除膀胱内可见病变组织。如输尿管膀胱开口清晰,给予膀胱镜下放置输尿管支架,解除输尿管梗阻(10例);如输尿管膀胱开口无法明确判断,不能放置支架管,则给予开放手术行输尿管膀胱再植(22例)。术后治疗包括膀胱灌注及口服药物抗感染和预防复发。结果:32例随访12～45个月,伴单侧肾积水并发症的腺性膀胱炎在尿常规缓解、膀胱镜下缓解、肾积水缓解以及最终是否行膀胱全切治疗等方面的结果显著优于伴双侧肾积水并发症的结果(P<0.05)。14例患者最终行膀胱全切(回肠膀胱或输尿管皮肤造瘘),两组均未发生癌变。结论:对于并发单侧肾积水并发症的腺性膀胱炎患者,积极的局部治疗有效,缓解率高;对于并发双侧肾积水并发症的腺性膀胱炎患者,积极的局部治疗效果差,最终往往需要行膀胱全切除术。

Analysis of the diagnosis and treatment of cystitis glandularis combinated with single and both side hydronephrosis

Objective:To study the diagnosis and treatment of cystitis glandularis complicated with hydronephrosis.Methods:A retrospective analysis of clinical data of 32 cases was performed.The cases were divided into 2 groups:single or bilateral hydronephrosis.The treatment included transurethral resection or electrovaporization,bladder instillation of drug,ureteral catheter and ureter replant.Results:All 25 cases have been followed up 12-45 months with a mean of 22 months,18 cases cured.The rate of cure and improvement is higher in single side hydronephrosis than in bilateral hydronephrosis(P<0.05).More patients with both side hydronephrosis were operated the total cystectomy.Conclusion:The suitable treatment for cystitis glandularis complicated with bilateral hydronephrosis may be the total cystectomy.