膀胱内翻性乳头状瘤的临床特征分析及后期膀胱灌注的治疗意义

发布时间：2018-04-27 13:08

本文选题：膀胱内翻性乳头状瘤 + 膀胱灌注　；参考：《青海大学》2017年硕士论文

【摘要】：目的:1.通过将临床中诊断为膀胱内翻性乳头状瘤的一般病例资料进行搜集整理,回顾性分析探讨总结,揭示此病相关临床特征及发生率。2.将收集的病例分组,观察经尿道膀胱肿瘤电切术联合表柔比星膀胱灌注和单纯经尿道膀胱肿瘤电切术在膀胱内翻性乳头状瘤中的疗效差别,探索优化的治疗方案,减少复发恶变率,减少后期不适症状的发生率。方法:1.搜集青海大学附属医院、青海省人民医院、西宁市第一人民医院、青海省中医院泌尿外科2011.03-2016.11期间内所有被确诊膀胱内翻性乳头状瘤的病人,对收集的所有病例进行一般情况、发病部位、临床表现等多个方面进行临床特征研究分析归纳总结,揭示其发生情况特点。2.将收集的病例分为两组,经尿道膀胱肿瘤电切术联合表柔比星膀胱灌注的定为A组,只行经尿道膀胱肿瘤电切术的定为B组,在术后按期进行尿脱落细胞学、泌尿系彩超或膀胱镜检查、病理活检相关检查,记录检查结果,比较两组患者的复发及恶变的情况,计算复发及恶变率;计算后期不适症状的实际发生情况。结果:1.总共收集64例患者,其中:男性53例,女性11例;50岁以内的23例,50岁及以上的41例;临床表现为间断性无痛肉眼血尿有31例,临床表现为尿频尿急尿痛有17例,临床表现为排尿困难的有6例,临床表现为下腹部腰背部酸胀不适感的有2例,无明显临床症状的有8例;尿常规检验结果:白细胞+~++++共有23例,红细胞+-~++++共有41例;1例多发,膀胱内可见3处大小不等的病灶,大小为10mm×13mm,14mm×21mm,25mm×36mm。63例单发,5例在膀胱左侧壁,8例膀胱在右侧壁,6例在底部,34例在颈部,11例在三角区;肿瘤直径在10mm以内的有21例,10mm-30mm的有39例,大于30mm的有4例;26例肿瘤外观呈基底部较宽的乳头或息肉状,38例肿瘤外观呈蒂较细的珊瑚样或海藻状。2.A组总例数34例,复发2例,恶变1例,复发率为5.88%,恶变率为2.94%;B组总例数30例,复发3例,恶变2例,复发率为10.00%,恶变率为6.67%。两组复发率及恶变率比较P0.05,差别均没有统计学意义。结论:1.IPB常发生于男性,女性少见,男女比例为5:1,常发病年龄在中年水平。2.IPB起病原因不清楚,与长期反复的膀胱炎性刺激、各种原因导致的下尿路梗阻、HPV(人类乳头瘤病毒)感染、化学性致癌物质因素以及吸烟等因素有密切联系。3.IPB以无痛性肉眼血尿为最多见,其次为尿频尿急尿痛、排尿困难或下腹部不适感症状,也有无明显临床症状的患者。4.膀胱IP比较常见的好发位置位于三角区、颈部以及双侧输尿管口附近区域,前列腺尿道部比较少见,膀胱顶部位置极少见。5.IPB的检查方式以膀胱镜检查和病理活检为主。6.IPB常常单发,多发情况较少出现,肿瘤多在3cm之内。7.IPB预后相对较好,复发和恶变率较低。8.A、B组复发率及恶变率对比,差别均没有统计学意义。
[Abstract]:Purpose 1. The clinical data of the patients diagnosed as inverted papilloma of the bladder were collected and analyzed retrospectively to reveal the clinical characteristics and incidence of the disease. The patients were divided into two groups to observe the effect of transurethral resection of bladder neoplasms combined with epirubicin instillation and simple transurethral resection of bladder tumors in patients with inverted papilloma of the bladder. The rate of recurrence and malignancy was reduced, and the incidence of late discomfort was reduced. Method 1: 1. To collect all the patients in the affiliated Hospital of Qinghai University, the people's Hospital of Qinghai Province, the first people's Hospital of Xining City, and the Department of Urology of Qinghai Provincial Hospital of Chinese Medicine during the period 2011.03-2016.11, all the patients who were diagnosed as turning inverted papilloma of the bladder, and the general information of all the cases collected, The location of the disease, clinical manifestations and other aspects of clinical characteristics were analyzed and summarized, revealing its occurrence characteristics. 2. 2. The patients were divided into two groups: group A with transurethral resection of bladder tumor and intravesical instillation of epirubicin, and group B with transurethral resection of bladder tumor. Urine exfoliative cytology was performed after operation. Urological ultrasound or cystoscopy, pathological biopsy related examination, record the results, compare the recurrence and malignancy of the two groups, calculate the recurrence and malignancy rate, calculate the actual occurrence of the late discomfort symptoms. The result is 1: 1. A total of 64 patients were collected, including 53 males and 11 females aged less than 50 years in 23 patients aged 50 or above, 31 patients with intermittent painless gross hematuria, and 17 patients with acute urinal pain with frequency of urination. The clinical manifestations were dysuria in 6 cases, acid distention in the lower abdomen and back in 2 cases, and no obvious clinical symptoms in 8 cases. There were 41 cases with multiple lesions in RBC-~, and 3 lesions of varying size were found in bladder. The size of the lesions was 10mm 脳 13mm ~ 14mm 脳 21mm ~ 25mm 脳 36mm.63 (5 cases). In the left wall of bladder, 8 cases were located in the right wall of bladder, 6 cases were located in the right wall, 34 cases were located in the neck and 11 cases were located in the triangle area. There were 39 cases with tumor diameter less than 10 mm ~ 30 mm in 10mm, 4 cases with tumor larger than 30mm, and 26 cases with large papilla or polyp at base. 38 cases had coral-like or seaweed shaped appearance with thin pedicle in 38 cases, and 2 cases recurred in group A, the tumor diameter was less than 10 mm ~ (30 mm), and 4 cases (n = 26) were larger than 30mm, and the appearance of tumor was coral-like or trehalous in appearance. In group B, there were 30 cases of malignant change, 3 cases of recurrence, 2 cases of malignant change, 10.00% of recurrence and 6.67% of malignant change. There was no significant difference in recurrence rate and malignant change rate between the two groups (P 0.05). Conclusions: 1. IPB often occurs in males and females, the ratio of male to female is 5: 1. The onset age of IPB is not clear. 2. The causes of IPB are unclear, which are associated with chronic repeated cystitis and various causes of lower urinary tract obstruction (human papillomavirus) infection. The factors of chemical carcinogen and smoking were closely related. 3. Painless naked hematuria was the most common factor of IPB, followed by frequent urination pain, dysuria or lower abdominal discomfort, and patients with no obvious clinical symptoms. The common location of bladder IP is located in the triangle area, neck and the area near the bilateral ureteral orifice, but the prostate urethra is rare. At the top of bladder, cystoscopy and pathological biopsy were the main methods of IPB examination. 6. IPB often appeared singly, and the multiple cases were rare. The prognosis of IPB was relatively good in 3cm .7.IPB. The recurrence rate and malignant change rate were lower. 8. There was no significant difference in recurrence rate and malignant change rate.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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