膀胱滑疝32例临床分析

目的 提高对成人膀胱滑疝的诊治水平.方法 回顾性分析1984年至2009年间32例成人膀胱滑疝患者的临床资料.32例患者患处均有不适感,存在大小不等的疝块.29例有尿频、尿急、排尿时疝块胀痛或发胀等泌尿系症状.15例有间断性分期排尿;29例疝块外观呈双峰形,当膀胱充盈时疝块增大,排尿后随即缩小;32例疝块均有波动感,叩诊呈实音.经导尿管向膀胱注入生理盐水疝块可增大,抽出则缩小;膀胱造影26例显示一哑铃形影像;B超检查29例潴尿时显示囊性肿块的液性暗区,其中2例有强回声光团,认定为脱出膀胱结石.结果 术前29例诊断膀胱滑疝,3例误诊(误诊率9.4%).32例经手术治疗治愈,其中术中误切膀胱2例;脱出膀胱并发结石2例;脱出膀胱壁极度薄弱2例,均行脱出膀胱切除亦治愈.32例随访1～5年均无复发.结论 膀胱滑疝一旦确定诊断,就应手术治疗.手术中熟悉病理解剖、仔细辨认剥离是防止误切或漏诊的关键.

Sliding hernia of the urinary bladder in 32 cases

Objective To improve the diagnosis and treatment of sliding hernia of adult urinary bladder. Methods Clinical data of 32 cases of adult sliding hernia of the bladder from 1984 to 2009 were analyzed retrospectively. Discomfort was complained in all the 32 patients along with palpable mass. Twentynine cases suffered from urgency of micturition, ascheturesis and dysuria, 15 cases had interruption of urination. The mass was saddle-shaped in 29 cases, when the bladder was filling. In all the 32 cases of hernia block were in a sense of fluctuations and flat on percussion. In 26 cases the bladder appeared a dumbbell-shaped image on cystography. By B-ultrasonic examination an opaque dark area of fluid was detected in 29 cases when there was retention of urine. Results Preoperatively 29 cases were diagnosed of bladder sliding hernia, 3 cases with misdiagnosis ( misdiagnosis rate of 9.4% ). 32 cases were cured by surgical treatment. The prolapsed portion of the bladder including stones in 2 cases were resected. 32 cases were followed up from 1 to 5 years without recurrence. Conclusions Once the sliding hernia of the bladder is diagnosed, patient should receive surgery. Intraoperatively the key of preventing inadvertent cut or missed diagnosis is familiar with pathological anatomy and careful exploration.