嗜酸性膀胱炎四例及文献复习

目的探讨嗜酸性膀胱炎(EC)的临床表现和诊治方法。方法回顾性总结1999年1月至2006年2月对4例EC患者的诊治体会。结果3例因血尿就诊,1例因背痛就诊。1例外周血嗜酸性细胞分类增高,2例膀胱内有类似肿瘤的占位性改变,2例有上尿路积水表现,4例均有镜下血尿,最终病理诊断为EC。对病例1和2分别行膀胱部分切除加回肠扩大膀胱术和经尿道电切术,术后半年膀胱镜检查无异常。病例3和4均予泼尼松、马来酸氯苯那敏和左旋氧氟沙星口服4周,2周后症状消除,B超检查示上尿路积水消退,静脉肾盂造影未见明显异常。病例3停药后随访18个月,无临床复发;病例4停药已2个月,目前仍随访中。结论EC较罕见,临床可有尿频、排尿困难、血尿、排尿痛或耻骨上区疼痛的表现,也可有尿潴留伴背痛的上尿路扩张症状及类似肿瘤的占位性改变,活检病理是有效的诊断方法。皮质激素、抗组织胺类药物联合抗生素是最常用且有效的保守治疗方法,手术亦为有效的治疗手段。

Eosinophilic cystitis, report of four cases with literature review

Objective To appraise the clinical features, diagnosis and treatment of eosinophilic cystitis. Methods From 1999 to 2006 four cases of eosinophilic cystitis were retrospectively reviewed. Results The predominant symptoms were hematuria in 3 cases, flank pain in one. One case had peripheral eosinophilia and another 2 cases showed intravesical neoplastic piolifecation in two. Urine analysis in all cases revealed microscopic hematuria. The pathological diagnosis in all of them was eosinophilic cystitis. Case 1 underwent partial cystectomy and case 2 underwent transurethral resection of the lesion. The female patients were treated with combined corticosteroids, antihistaminic and antibiotics therapy with good results. Conclusion Eosinophilic cystitis is very rare manifesting as wrinary frequency painful difficult mictunition, hematuria or pain over superpubie region, it can also have urine retention with back pain , upper urinary tract dilatation and neoplastic-like piolifecation. Cystoscopic biopsy is the accurate diagnostic method. Corticosteroid, antihistamine and antibiotics are the usual conservative treatment. Tra surethral intervention could be the best choice of consideration.