膀胱非上皮性肿瘤的诊治

目的 总结膀胱非上皮性肿瘤的诊治经验。方法 对1953～2002年收治的28例膀胱非上皮性肿瘤患者的诊治情况进行总结、分析。结果 膀胱非上皮性肿瘤的主要临床表现为血尿、盆腔肿块、尿频、排尿困难等症状。主要辅助检查为B超、CT、膀胱镜检查及镜下活检。本组28例中,经术后病理检查,恶性肿瘤17例(占61．7％),有7种病理类型,分别为膀胱横纹肌肉瘤、膀胱小细胞癌、膀胱平滑肌肉瘤、膀胱恶性淋巴瘤、膀胱恶性纤维组织细胞瘤、膀胱脂肪肉瘤、膀胱黑色素瘤;良性11例(占39．3％),有4种病理类型,分别为膀胱海绵状血管瘤、膀胱壁纤维瘤、膀胱平滑肌瘤、膀胱嗜铬细胞瘤。11例良性肿瘤均完整切除或电灼、电切。17例恶性肿瘤中,膀胱部分切除术7例、膀胱全切除术9例、无法切除1例,有7例恶性肿瘤因复发多次行手术切除。17例恶性肿瘤患者均获随访,3年存活率47．0％(8／17)。结论 膀胱非上皮性肿瘤临床少见,病理类型复杂,恶性居多且预后较差,良性肿瘤预后较好。术前诊断率低,膀胱镜下深部活检可提高诊断率。手术是该病的主要治疗方法。良性肿瘤应完整切除,恶性肿瘤应争取广泛切除,结合其病理特点辅助放化疗可能提高疗效。

Non-epithelial tissue tumors of the urinary bladder

OBJECTIVE: To summarize the experience in the diagnosis and treatment of non-epithelial tissue tumor of urinary bladder. METHODS: >From 1953 to April 2002, a total of 28 patients with non-epithelial tissue tumor in 3 925 bladder tumor cases were analyzed. RESULTS: Painless gross hematuria, pelvic mass, urinary frequency and dysuria are symptoms of non-epithelial bladder tumor. Ultrasonic examination, computed tomography (CT) scan, cystoscopy and biopsy is used for diagnosis of the tumor. Seventeen of 28 patients (61.7%) were malignant neoplasms in 7 kinds of pathologic types, which was small cell carcinoma (5 cases), rhabdomyosarcoma (4 cases), leiomyosarcoma (4 cases), lymphoma (1 case), malignant fibrous histiocytoma (1 case), liposarcoma(1 case), melanoma (1 case) respectively. Eleven of 28 patients (39.3%) were benign tumors with 4 kinds of histologic types including 2 cases of cavarnous hemangioma, 1 case of fibroma, 1 case of leiomyoma, 7 cases of pheochromocytom. All benign tumor patients were treated with partial cystectomy, transurethral bladder tumor resect (TURBT) and fulguration. In 17 malignant neoplasms patients, 7 of them received partial cystectomy, 9 received radical cystectomy, and 1 patient's tumor was unresectable. Those malignant bladder tumor patient are followed up, but 3 years survival rates is only 8/17. CONCLUSIONS: Non-epithelial tissue tumor of the urinary bladder is rare with complicated pathologic types. Malignant neoplasms are more than benign tumors with very poor prognosis, benign tumors' prognosis is good. Diagnosis rate which was confirmed before operation is low. Dip biopsy under cystoscopy may enhance the diagnosis rate. Surgical treatment is the main therapy for non-epithelial tissue tumor of the urinary bladder. Because of the aggressive biologic behavior of malignant tumors, they should be identified promptly and treated appropriately. According to the histologic appearance radiotherapy and chemotherapy is mandatory in some cases.